@VirusesImmunity@washingtonpost@YaleMed The dream is to bring together life science, data science, clinical epidemiology, & digital technologies/software to solve previously intractable conditions that cause much suffering. And to do so in true partnership w/those facing the condition, being worthy of trust every day.
@VirusesImmunity@washingtonpost@YaleMed We will enlist learning community, participating together, sharing wisdom, & being co-producers of research, in traditional & non-traditional ways- setting new standard for quality & speed & utility of the knowledge generated. Researchers working for & on behalf of the community.
@VirusesImmunity@washingtonpost@YaleMed The primary thesis is that the most successful clinical research of the future will be in deep partnership with those affected… and leverage technology to ease information flow, preserve privacy, and accelerate knowledge generation and sharing. There is a new era afoot.
@VirusesImmunity@washingtonpost@YaleMed The alternative methods bypass patients in research, consider them just a source of data, a point of failure (I have heard this) in the work process - people to leverage… rather than a authentic partners whose wisdom and engagement can transform how we generate knowledge.
@VirusesImmunity@washingtonpost@YaleMed The partnership model can overcome the fact that so few people participate in research even though they so need for the research to be done and so hopeful it will produce breakthroughs. The disconnect has been not to treat these people as valued teammates.
@VirusesImmunity@washingtonpost@YaleMed@FrancesSSellers I said about #longcovid: "Viewing long covid purely as a psychogenic illness will do little to counter the public health threat the country now faces, Krumholz said, or to address the lingering suffering from other potentially post-infectious conditions."
This @NEJM paper really puzzled me and I wonder what I am missing. It addresses good question…should people on antidepressants in primary care, who are doing well, discontinue them? And good methods, randomized, double-blind trial treated in the UK. But… nejm.org/doi/full/10.10…
@NEJM They randomize 478 people w/at least 2 depressive episodes and w/ at least 2 years of treatment with antidepressant agents. They discontinue in half (after a taper) and replace with placebo. Primary outcome is relapse of depressive symptoms. OK, good so far. But...
@NEJM At a year, relapse occurred in 39% of those continuing antidepressants and 56% in the discontinuation group. Now that means that 44% of those who discontinued did fine. That seems really good - and a chance many would take. And that continuing still had a horrific relapse rate.
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…
"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