Our paper dropped: Performance Metrics for Comparative Analysis of Clinical Risk Prediction Models Employing Machine Learning. We show 'commonly reported metrics may not have sufficient sensitivity to identify improvement of #ML models…’ @CircOutcomesahajournals.org/doi/abs/10.116…
@CircOutcomes A premise of our paper is... traditional metrics of risk models may miss some of the advantages of #ML#AI models that capture better the risk of some patients, esp at the extremes of risk. In a precision approach, getting it right on each person matters. @YaleMed@YaleCardiology
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"The @PCORI Board’s approval of $61.3 million will enable eight PCORnet CRNs to optimize their infrastructure resources and capacities to support PCORnet in its third phase." What is the total spent on PCORnet to date? What are the deliverables to date? pcori.org/news-release/p…
@PCORI And asking w/respect, just think the accounting of resources spent & deliverables provided is good hygiene for funders. And what resources from the effort are publicly available for others to leverage? Since this is such a big investment, regular reports on ROI is useful. @PCORI
@PCORI And this might be available, I just didn’t know where to look. By the way, similarly with @NIH, who previously reported that almost half of their funded trials were never published. Quarterly reports on trial funding and deliverables (results reported), for example, also great.
With much talk about wearables & devices picking up unappreciated atrial fibrillation, I was intrigued by this randomized trial of effect of an implantable loop recorder to detect afib on outcomes. These slides are from #ESCCongress presentation. Kudos Jesper Svendsen and team.
The team identified participants with a high risk of stroke and randomized them to an implantable loop recorder (Reveal LINQ by Medtronic), with a primary outcome of stroke or systemic embolism. Question: would better detection of afib improve outcomes?
They randomized 1:3 - so most people were in the control group. 1501 randomized to the implantable recorder (and 1420 received it, that will be important later) and 4503 in the control group (and none crossed over and received the recorder). They followed them for median 65 mos.
CardioMEMS. Expensive, invasive device. Initial trial contaminated. FDA approves & it sells. Definitive trial now completed yrs later. No sig benefit. However, authors, look only at pre-COVID results, claim benefit, conclude it's worthwhile. #ESCcongressthelancet.com/action/showPdf…
Authors write: 'In conclusion, haemodynamic-guided management
across spectrum of ejection fraction & symptom severity was safe but did not reduce a composite of mortality and total heart failure events.” This seems very straightforward. We should stop using it. #ESCCongress2021
Then they say… "in a pre-COVID-19 analysis, a benefit of haemodynamic-guided management on the primary outcome, driven by a decrease in heart failure hospitalisations, was shown… supporting benefits of haemodynamic-guided management in patients with chronic heart failure."
Remarkable win streak for SGLT2i drugs continues…now specifically for heart failure with preserved ejection fraction (HFpEF), where effective therapies are scarce. Empagloflozin benefits one of every ~30 people treated over median of 26 mos. nejm.org/doi/full/10.10…#ESCCongress
What gives me confidence about the finding is it is consistent w/what we have seen in subgroups of other studies, but not yet in a dedicated trial. Kudos @JavedButler1 Stefan Anker and team. This is truly a landmark in heart failure care. #ESCCongress2021#ESCcongress@escardio
@JavedButler1@escardio Another notable about this EMPEROR-Preserved trial… empaglifozin won across a range of outcomes, across all the subgroups (incl people w/o diabetes), and w/o evidence of safety issues (more serious safety issues in the placebo group). Very welcome set of findings. #ESCcongress
Illuminating the disparities… "During COVID-19, Black & AI/AN persons had highest excess all-cause mortality IRs among <25yrs & 25–64 years; among ≥65 yrs, largest excess mortality occurred among Black & Hispanic persons.” @CDCgov@jeremyfaust@YaleMedcdc.gov/mmwr/volumes/7…
@CDCgov@jeremyfaust@YaleMed We learned a lot in researching this study…using the metric we pioneered (I credit @YNHH CORE team and @jeremyfaust) we show: 'Black persons had highest excess mortality IR among <25 yrs with 14.1 excess deaths per 100,000 person-years in 2020, followed by AI/AN persons (6.5)."
@CDCgov@jeremyfaust@YaleMed@YNHH Also, "Among adults aged 25–64 years, the highest total excess mortality IR was among AI/AN persons (221.1), followed by Black (133.4), NH/PI (124.9), Hispanic (98.5), White (51.2) and Asian persons (30.2).” These differences are huge and demand our attention.
For States and regions in the US that have low vaccination rates because people don’t want it, wouldn’t the federal gov’t be better off waiting until they ask for help rather than trying to push/force vaccinations on them, which just seems to increase resistance.
In this construct, the federal gov’t would say, we are ready and eager to help with vaccines, funding, people - let us know when you are ready. This, in place of being characterized as forcing people. De-politicize it… feds just wait to be invited to help.
The key is to make vaccines accessible and free to everyone; make trustworthy information about the vaccines abundant and clear. And let people make their choices. Be the sun and not the wind, and people will eventually take off their coats.