@rahatheart1 @rafasadaba @ovidiogarciav @Almanfi_Cardio @Coronary4front @FaisalBakaeen @mirvatalasnag @SukhNijjer I enjoy a good observational study as much as anyone, but this is not one of those. Even without reading the full paper, I can see 2 obvious signs that this study is hopelessly confounded based on the original tweet. Challenge to the #CardioTwitter community to find the 2 clues. @rahatheart1 @rafasadaba @ovidiogarciav @Almanfi_Cardio @Coronary4front @FaisalBakaeen @mirvatalasnag @SukhNijjer 1/x- OK, for those of you have been waiting patiently for my thoughts as to why this study is so obviously confounded, here's the long tweetorial.

1/x Mini-Tweetorial on External Validity vs. Competing Risk.

Based on an ongoing discussion with @drjohnm , @ATSandhu , @gcfmd, @mikejohansenmd and others, I have put together this mini-tweetorial on how to think about external validity of trials vs. competing risks. 2/x A lot of these concepts are ones that I have learned over the years from disease-simulation modeling, but haven’t necessarily seen put together in a case example. I hope folks find this helpful.

@mirvatalasnag @PCRonline @modine_thomas @pomyers @drptca @VDelgadoGarcia @6ayyeboon @stefan_harb @didier_tchetche @CuissetDr @cardioPCImom 1/ Although it is tempting to blame industry for hype and ICs for "indication creep" (both of which are undoubtedly part of the story), the true story is much more complex and less nefarious. @mirvatalasnag @PCRonline @modine_thomas @pomyers @drptca @VDelgadoGarcia @6ayyeboon @stefan_harb @didier_tchetche @CuissetDr @cardioPCImom 2/ Much of the reason why TEER is not currently combined with annuloplasty—at least in the US-- relates to regulatory considerations, which are very different for devices (FDA) vs. surgical procedures (none).

My first ever tweetorial! In the last 48 hours, there has been a lot of buzz in the lay press (WSJ, CNN) about a new observational study of hydroxychloroquine (HCQ) in COVID-19 (ijidonline.com/article/S1201-…). In case you haven't seen it, the single-center study demonstrates a very strong association between early treatment with HCQ for hospitalized patients and a substantial (50% or greater) reduction in the risk of 28-day mortality.

Although Italy had its worst day to date (6557 new cases, 793 deaths), in the "silver lining" department, it’s clear that COVID-19 cases and deaths are not growing exponentially in Italy anymore. I made a simple spreadsheet using data from worldometers.info/coronavirus/co… to track the total number of cumulative and incident cases and deaths over the last 2 weeks (since 3/8).

@ATSandhu @venkmurthy @AnkurKalraMD @rwyeh @annalsthorsurg @drjohnm @SajjadRazaMD @JAMANetworkOpen @adnanalkhouli To clarify, "outpatient PCI" has nothing to do with whether the patient stayed in the hospital overnight or not. Since ~2013, an outpatient PCI is one for which the patient wasnot expected to be in the hospital for 2 midnights (i.e., virtually all elective PCI procedures).(1/x) @ATSandhu @venkmurthy @AnkurKalraMD @rwyeh @annalsthorsurg @drjohnm @SajjadRazaMD @JAMANetworkOpen @adnanalkhouli Prior to 2013, the rules were a bit more nebulous but a large proportion of PCIs for SIHD/UA would have been coded as outpatient status as well-- at least starting in 2008, when the RAC audits to identify improper use of inpatient status for PCI went into effect. (2/x)