Critical Appraisal of Literature Estimate of Clinical Benefits The Roadmap for Evidence Based Clinical Practice Suzana Alves da Silva, MD, MSc Coordinator of Research & Development Teaching and Research Center of Pró-Cardíaco
Presented At The Workshop On Clinical Research From HCor, São Paulo, Brasil, As Part Of The Clinical Research National Program Of The Brazilian Health Ministry (December 4, 2009) domingo, 16 de maio de 2010
1
Center for Education Research and Evaluation
CLARITY Group
Teaching and Research Center of Pr贸-Card铆aco
domingo, 16 de maio de 2010
2
The Action Domains
Clinical Action Domains THERAPY
DIAGNOSIS
Ask
Ask
Ask
Ask
Acquire
Acquire
Acquire
Acquire
Appraise
Appraise
Appraise
Appraise
Apply
Apply
Apply
Apply
domingo, 16 de maio de 2010
PROGNOSIS
HARM
3
domingo, 16 de maio de 2010
4
What are the most important results?
domingo, 16 de maio de 2010
5
Critical Appraisal of the Results Diagnosis
Prognosis
Therapy
Harm Performance
Utility
Pre-test prob
Frequency RR, OR, HR
LR
Impact
RD, NNT
Pos-test prob
RD
Precision
CI
CI
CI
domingo, 16 de maio de 2010
Utility
Risk RR, OR, HR
Effect
Performance
RR, OR, HR
CI
RR, OR, HR
RR, OR, HR
RD
RD, NNH
CI
CI 6
Absolute Risk at 1 year Control
domingo, 16 de maio de 2010
Intervention
7
Absolute Risk at 1 year Control
Intervention
0,8
0,6
0,4
0,2
0
Population A domingo, 16 de maio de 2010
Population B
Population C
Population D
7
Absolute Risk at 1 year Control
Intervention
0,8
0,6
0,4
0,2
0
80% Population A domingo, 16 de maio de 2010
Population B
Population C
Population D
7
Absolute Risk at 1 year Control
Intervention
0,8
0,6
0,4
0,2
0
80% Population A domingo, 16 de maio de 2010
40% Population B
Population C
Population D
7
Absolute Risk at 1 year Control
Intervention
0,8
0,6
0,4
0,2
0
80% Population A domingo, 16 de maio de 2010
40% Population B
20% Population C
Population D
7
Absolute Risk at 1 year Control
Intervention
0,8
0,6
0,4
0,2
0
80% Population A domingo, 16 de maio de 2010
40% Population B
20% Population C
10% Population D
7
Absolute Risk at 1 year Control
Intervention
0,8
0,6
0,4
0,2
0
80%
60,0%
Population A domingo, 16 de maio de 2010
40% Population B
20% Population C
10% Population D
7
Absolute Risk at 1 year Control
Intervention
0,8
0,6
0,4
0,2
0
80%
60,0%
Population A domingo, 16 de maio de 2010
40% 30,0% Population B
20% Population C
10% Population D
7
Absolute Risk at 1 year Control
Intervention
0,8
0,6
0,4
0,2
0
80%
60,0%
Population A domingo, 16 de maio de 2010
40% 30,0% Population B
20% 15,0% Population C
10% Population D
7
Absolute Risk at 1 year Control
Intervention
0,8
0,6
0,4
0,2
0
80%
60,0%
Population A domingo, 16 de maio de 2010
40% 30,0% Population B
20% 15,0% Population C
10% 7,5% Population D
7
Impact Measure Risk Difference Controle
domingo, 16 de maio de 2010
Intervenção
8
Impact Measure Risk Difference Controle
Intervenção
0,8
0,6
0,4
0,2
0
População A domingo, 16 de maio de 2010
População B
População C
População D
8
Impact Measure Risk Difference Controle
Intervenção
0,8
0,6
0,4
0,2
0
80%
60,0%
População A domingo, 16 de maio de 2010
População B
População C
População D
8
Impact Measure Risk Difference Controle
Intervenção
0,8
20%
0,6
0,4
0,2
0
80%
60,0%
População A domingo, 16 de maio de 2010
População B
População C
População D
8
Impact Measure Risk Difference Controle
Intervenção
0,8
20%
0,6
0,4
0,2
0
80%
60,0%
População A domingo, 16 de maio de 2010
40% 30,0% População B
População C
População D
8
Impact Measure Risk Difference Controle
Intervenção
0,8
20%
0,6
10%
0,4
0,2
0
80%
60,0%
População A domingo, 16 de maio de 2010
40% 30,0% População B
População C
População D
8
Impact Measure Risk Difference Controle
Intervenção
0,8
20%
0,6
10%
0,4
0,2
0
80%
60,0%
População A domingo, 16 de maio de 2010
40% 30,0% População B
20% 15,0% População C
População D
8
Impact Measure Risk Difference Controle
Intervenção
0,8
20%
0,6
10%
0,4
5%
0,2
0
80%
60,0%
População A domingo, 16 de maio de 2010
40% 30,0% População B
20% 15,0% População C
População D
8
Impact Measure Risk Difference Controle
Intervenção
0,8
20%
0,6
10%
0,4
5%
0,2
0
80%
60,0%
População A domingo, 16 de maio de 2010
40% 30,0% População B
20% 15,0% População C
10% 7,5% População D
8
Impact Measure Risk Difference Controle
Intervenção
0,8
20%
0,6
10%
0,4
0
80%
60,0%
População A domingo, 16 de maio de 2010
40% 30,0% População B
20% 15,0% População C
2,5%
5%
0,2
10% 7,5% População D
8
Impact Measure Controle
Intervenção
0,8
20%
0,6
10%
0,4
0
80%
60,0%
População A domingo, 16 de maio de 2010
40% 30,0% População B
20% 15,0% População C
2,5%
5%
0,2
10% 7,5% População D
8
Other ways to express impact measures
domingo, 16 de maio de 2010
9
Other ways to express impact measures ARR 20%
domingo, 16 de maio de 2010
NNT 100
20
5
X
1
10%
100
10
10
5%
100
5
20
2,5%
100
2,5
40 9
Other ways to express impact measures ARR 20%
domingo, 16 de maio de 2010
NNT 100
20
5
X
1
10%
100
10
10
5%
100
5
20
2,5%
100
2,5
40 9
Other ways to express impact measures ARR 20%
domingo, 16 de maio de 2010
NNT 100
20
5
X
1
10%
100
10
10
5%
100
5
20
2,5%
100
2,5
40 9
Other ways to express impact measures ARR 20%
domingo, 16 de maio de 2010
NNT 100
20
5
X
1
10%
100
10
10
5%
100
5
20
2,5%
100
2,5
40 9
Other ways to express impact measures ARR 20%
domingo, 16 de maio de 2010
NNT 100
20
5
X
1
10%
100
10
10
5%
100
5
20
2,5%
100
2,5
40 9
Other ways to express impact measures ARR 20%
domingo, 16 de maio de 2010
NNT 100
20
5
X
1
10%
100
10
10
5%
100
5
20
2,5%
100
2,5
40 9
Other ways to express impact measures ARR 20%
domingo, 16 de maio de 2010
NNT 100
20
5
X
1
10%
100
10
10
5%
100
5
20
2,5%
100
2,5
40 9
Other ways to express impact measures ARR 20%
domingo, 16 de maio de 2010
NNT 100
20
5
X
1
10%
100
10
10
5%
100
5
20
2,5%
100
2,5
40 9
Other ways to express impact measures ARR 20%
domingo, 16 de maio de 2010
NNT 100
20
5
X
1
10%
100
10
10
5%
100
5
20
2,5%
100
2,5
40 9
Other ways to express impact measures ARR 20%
domingo, 16 de maio de 2010
NNT 100
20
5
X
1
10%
100
10
10
5%
100
5
20
2,5%
100
2,5
40 9
Other ways to express impact measures ARR 20%
domingo, 16 de maio de 2010
NNT 100
20
5
X
1
10%
100
10
10
5%
100
5
20
2,5%
100
2,5
40 9
Other ways to express impact measures ARR 20%
domingo, 16 de maio de 2010
NNT 100
20
5
X
1
10%
100
10
10
5%
100
5
20
2,5%
100
2,5
40 9
Other ways to express impact measures ARR 20%
domingo, 16 de maio de 2010
NNT 100
20
5
X
1
10%
100
10
10
5%
100
5
20
2,5%
100
2,5
40 9
Measures of Effect or Association ✤
Relative Risk
✤
Odds Ratio
✤
Harzard Ratio
domingo, 16 de maio de 2010
10
What is Relative Risk then? Control
Intervention
0,8
20%
0,6
10%
0,4
0
80%
60,0%
Population A domingo, 16 de maio de 2010
40% 30,0% Population B
20% 15,0% Population C
2,5%
5%
0,2
10% 7,5% Population D
11
What is Relative Risk then? Control
Intervention
0,8
20%
0,6
60 / 80 = 0,75
10%
0,4
0
80%
60,0%
Population A domingo, 16 de maio de 2010
40% 30,0% Population B
20% 15,0% Population C
2,5%
5%
0,2
10% 7,5% Population D
11
What is Relative Risk then? Control
Intervention
0,8
20%
0,6
60 / 80 = 0,75
10%
0,4
30 / 40 = 0,75
0
80%
60,0%
Population A domingo, 16 de maio de 2010
40% 30,0% Population B
20% 15,0% Population C
2,5%
5%
0,2
10% 7,5% Population D
11
What is Relative Risk then? Control
Intervention
0,8
20%
0,6
60 / 80 = 0,75
10%
0,4
30 / 40 = 0,75 15 / 20 = 0,75
0
80%
60,0%
Population A domingo, 16 de maio de 2010
40% 30,0% Population B
20% 15,0% Population C
2,5%
5%
0,2
10% 7,5% Population D
11
What is Relative Risk then? Control
Intervention
0,8
20%
0,6
60 / 80 = 0,75
10%
0,4
30 / 40 = 0,75 15 / 20 = 0,75
0
80%
60,0%
Population A domingo, 16 de maio de 2010
40% 30,0% Population B
20% 15,0% Population C
2,5%
5%
0,2
7,5 / 10 = 0,75
10% 7,5% Population D
11
And Relative Risk Reduction? Control
domingo, 16 de maio de 2010
Intervention
RR= 0,75
12
And Relative Risk Reduction? Control
Intervention
RR= 0,75
0,8
0,6
0,4
0,2
0
Population A domingo, 16 de maio de 2010
Population B
Population C
Population D
12
And Relative Risk Reduction? Control
Intervention
RR= 0,75
0,8
0,6
0,4
0,2
0
80%
60,0%
Population A domingo, 16 de maio de 2010
Population B
Population C
Population D
12
And Relative Risk Reduction? Control
Intervention
20 / 80
0,8
RR= 0,75
RRR = 0,25
0,6
0,4
0,2
0
80%
60,0%
Population A domingo, 16 de maio de 2010
Population B
Population C
Population D
12
And Relative Risk Reduction? Control
Intervention
20 / 80
0,8
RR= 0,75
RRR = 0,25
0,6
0,4
0,2
0
80%
60,0%
Population A domingo, 16 de maio de 2010
40% 30,0% Population B
Population C
Population D
12
And Relative Risk Reduction? Control
20 / 80
0,8
RR= 0,75
Intervention
RRR = 0,25
0,6
RRR = 0,25 10 / 40
0,4
0,2
0
80%
60,0%
Population A domingo, 16 de maio de 2010
40% 30,0% Population B
Population C
Population D
12
And Relative Risk Reduction? Control
20 / 80
0,8
RR= 0,75
Intervention
RRR = 0,25
0,6
RRR = 0,25 10 / 40
0,4
0,2
0
80%
60,0%
Population A domingo, 16 de maio de 2010
40% 30,0% Population B
20% 15,0% Population C
Population D
12
And Relative Risk Reduction? Control
20 / 80
0,8
RR= 0,75
Intervention
RRR = 0,25
0,6
RRR = 0,25
0,2
0
80%
60,0%
Population A domingo, 16 de maio de 2010
40% 30,0% Population B
RRR = 0,25 5 / 20
10 / 40
0,4
20% 15,0% Population C
Population D
12
And Relative Risk Reduction? Control
20 / 80
0,8
RR= 0,75
Intervention
RRR = 0,25
0,6
RRR = 0,25
0,2
0
80%
60,0%
Population A domingo, 16 de maio de 2010
40% 30,0% Population B
RRR = 0,25 5 / 20
10 / 40
0,4
20% 15,0% Population C
10% 7,5% Population D
12
And Relative Risk Reduction? Control
20 / 80
0,8
RR= 0,75
Intervention
RRR = 0,25
0,6
RRR = 0,25
0
80%
60,0%
Population A domingo, 16 de maio de 2010
40% 30,0% Population B
20% 15,0% Population C
RRR = 0,25 2,5 / 10
0,2
RRR = 0,25 5 / 20
10 / 40
0,4
10% 7,5% Population D
12
And Relative Risk Reduction? Control
20 / 80
0,8
RR= 0,75
Intervention
RRR= 0,25
RRR = 0,25
0,6
RRR = 0,25
0
80%
60,0%
Population A domingo, 16 de maio de 2010
40% 30,0% Population B
20% 15,0% Population C
RRR = 0,25 2,5 / 10
0,2
RRR = 0,25 5 / 20
10 / 40
0,4
10% 7,5% Population D
12
And Relative Risk Reduction? Control
20 / 80
0,8
RR= 0,75 + RRR= 0,25
Intervention
RRR = 0,25
0,6
RRR = 0,25
0
80%
60,0%
Population A domingo, 16 de maio de 2010
40% 30,0% Population B
20% 15,0% Population C
RRR = 0,25 2,5 / 10
0,2
RRR = 0,25 5 / 20
10 / 40
0,4
10% 7,5% Population D
12
And Relative Risk Reduction? Control
20 / 80
0,8
RR= 0,75 + RRR= 0,25 = 1
Intervention
RRR = 0,25
0,6
RRR = 0,25
0
80%
60,0%
Population A domingo, 16 de maio de 2010
40% 30,0% Population B
20% 15,0% Population C
RRR = 0,25 2,5 / 10
0,2
RRR = 0,25 5 / 20
10 / 40
0,4
10% 7,5% Population D
12
Why the measures of association are more frequently used in Systematic Reviews? 5 year mortality rate in the drug eluting stents trials: All Sirius - Sirius - Ravel
RR (95% CI)
Studies
% Weight
All - Sirius
1,32(0,63-2,78)
48
Pache
1,40(0,45-4,35)
19,9
Ravel
1,72(0,75-3,95)
32,1
Overall 95% CI 0,23
1,47 (0,89-241) 1
4,35 Int J Epidemiol 2002;31:72-6.
domingo, 16 de maio de 2010
13
Measures of Effect Odds Ratio
✤
What is Odds?
domingo, 16 de maio de 2010
14
Difference between Risk and Odds
domingo, 16 de maio de 2010
15
Difference between Risk and Odds Probability of Occurring
Probability of not Occurring
Odds
P
1-P
P/(1-P)
Risk of occurring the number 1:
Risk of not occurring the number 1:
1/5
1/6
domingo, 16 de maio de 2010
5/6
15
Difference between Risk and Odds Probability of Occurring
Probability of not Occurring
Odds
P
1-P
P/(1-P)
Risk of occurring the number 1:
Risk of not occurring the number 1:
1/5
1/6
domingo, 16 de maio de 2010
5/6
15
Difference between Risk and Odds Probability of Occurring
Probability of not Occurring
Odds
P
1-P
P/(1-P)
Risk of occurring the number 1:
Risk of not occurring the number 1:
1/5
1/6
domingo, 16 de maio de 2010
5/6
15
Difference between Risk and Odds Probability of Occurring
Probability of not Occurring
Odds
P
1-P
P/(1-P)
Risk of occurring the number 1:
Risk of not occurring the number 1:
1/5
1/6
domingo, 16 de maio de 2010
5/6
15
Difference between Risk and Odds Probability of Occurring
Probability of not Occurring
Odds
P
1-P
P/(1-P)
Risk of occurring the number 1:
Risk of not occurring the number 1:
1/5
1/6
domingo, 16 de maio de 2010
5/6
15
Difference between Risk and Odds
domingo, 16 de maio de 2010
16
Difference between Risk and Odds Risk of occurring... Risk of not occurring...
Odds
P
1-P
P/(1-P)
50%
50%
1
40%
60%
0,66
30%
70%
0,43
20%
80%
0,25
10%
90%
0,11
5%
95%
0,052
domingo, 16 de maio de 2010
16
Difference between Risk and Odds Risk of occurring... Risk of not occurring...
Odds
P
1-P
P/(1-P)
50%
50%
1
40%
60%
0,66
30%
70%
0,43
20%
80%
0,25
10%
90%
0,11
5%
95%
0,052
domingo, 16 de maio de 2010
16
Difference between Risk and Odds Risk of occurring... Risk of not occurring...
Odds
P
1-P
P/(1-P)
50%
50%
1
40%
60%
0,66
30%
70%
0,43
20%
80%
0,25
10%
90%
0,11
5%
95%
0,052
domingo, 16 de maio de 2010
16
Difference between Risk and Odds Risk of occurring... Risk of not occurring...
Odds
P
1-P
P/(1-P)
50%
50%
1
40%
60%
0,66
30%
70%
0,43
20%
80%
0,25
10%
90%
0,11
5%
95%
0,052
domingo, 16 de maio de 2010
16
Difference between Risk and Odds Risk of occurring... Risk of not occurring...
Odds
P
1-P
P/(1-P)
50%
50%
1
40%
60%
0,66
30%
70%
0,43
20%
80%
0,25
10%
90%
0,11
5%
95%
0,052
domingo, 16 de maio de 2010
16
Difference between Risk and Odds Risk of occurring... Risk of not occurring...
Odds
P
1-P
P/(1-P)
50%
50%
1
40%
60%
0,66
30%
70%
0,43
20%
80%
0,25
10%
90%
0,11
5%
95%
0,052
domingo, 16 de maio de 2010
16
Difference between Risk and Odds Risk of occurring... Risk of not occurring...
Odds
P
1-P
P/(1-P)
50%
50%
1
40%
60%
0,66
30%
70%
0,43
20%
80%
0,25
10%
90%
0,11
5%
95%
0,052
domingo, 16 de maio de 2010
16
Difference between Risk and Odds Risk of occurring... Risk of not occurring...
Odds
P
1-P
P/(1-P)
50%
50%
1
40%
60%
0,66
30%
70%
0,43
20%
80%
0,25
10%
90%
0,11
5%
95%
0,052
domingo, 16 de maio de 2010
16
Difference between Risk and Odds Risk of occurring... Risk of not occurring...
Odds
P
1-P
P/(1-P)
50%
50%
1
40%
60%
0,66
30%
70%
0,43
20%
80%
0,25
10%
90%
0,11
5%
95%
0,052
domingo, 16 de maio de 2010
16
Difference between Risk and Odds Risk of occurring... Risk of not occurring...
Odds
P
1-P
P/(1-P)
50%
50%
1
40%
60%
0,66
30%
70%
0,43
20%
80%
0,25
10%
90%
0,11
5%
95%
0,052
domingo, 16 de maio de 2010
16
Difference between Risk and Odds Risk of occurring... Risk of not occurring...
Odds
P
1-P
P/(1-P)
50%
50%
1
40%
60%
0,66
30%
70%
0,43
20%
80%
0,25
10%
90%
0,11
5%
95%
0,052
domingo, 16 de maio de 2010
16
Difference between Risk and Odds Risk of occurring... Risk of not occurring...
Odds
P
1-P
P/(1-P)
50%
50%
1
40%
60%
0,66
30%
70%
0,43
20%
80%
0,25
10%
90%
0,11
5%
95%
0,052
domingo, 16 de maio de 2010
16
Difference between Risk and Odds Risk of occurring... Risk of not occurring...
Odds
P
1-P
P/(1-P)
50%
50%
1
40%
60%
0,66
30%
70%
0,43
20%
80%
0,25
10%
90%
0,11
5%
95%
0,052
domingo, 16 de maio de 2010
16
Difference between Risk and Odds Risk of occurring... Risk of not occurring...
Odds
P
1-P
P/(1-P)
50%
50%
1
40%
60%
0,66
30%
70%
0,43
20%
80%
0,25
10%
90%
0,11
5%
95%
0,052
domingo, 16 de maio de 2010
16
Difference between Risk and Odds Risk of occurring... Risk of not occurring...
Odds
P
1-P
P/(1-P)
50%
50%
1
40%
60%
0,66
30%
70%
0,43
20%
80%
0,25
10%
90%
0,11
5%
95%
0,052
domingo, 16 de maio de 2010
16
Difference between Risk and Odds Risk of occurring... Risk of not occurring...
Odds
P
1-P
P/(1-P)
50%
50%
1
40%
60%
0,66
30%
70%
0,43
20%
80%
0,25
10%
90%
0,11
5%
95%
0,052
domingo, 16 de maio de 2010
16
Difference between Risk and Odds Risk of occurring... Risk of not occurring...
Odds
P
1-P
P/(1-P)
50%
50%
1
40%
60%
0,66
30%
70%
0,43
20%
80%
0,25
10%
90%
0,11
5%
95%
0,052
domingo, 16 de maio de 2010
16
Difference between Risk and Odds Risk of occurring... Risk of not occurring...
Odds
P
1-P
P/(1-P)
50%
50%
1
40%
60%
0,66
30%
70%
0,43
20%
80%
0,25
10%
90%
0,11
5%
95%
0,052
domingo, 16 de maio de 2010
16
Difference between Risk and Odds Risk of occurring... Risk of not occurring...
Odds
P
1-P
P/(1-P)
50%
50%
1
40%
60%
0,66
30%
70%
0,43
20%
80%
0,25
10%
90%
0,11
5%
95%
0,052
domingo, 16 de maio de 2010
16
Difference between Risk and Odds Risk of occurring... Risk of not occurring...
Odds
P
1-P
P/(1-P)
0,5
50%
1
0,4
60%
0,66
0,3
70%
0,43
0,2
80%
0,25
0,1
90%
0,11
0,05
95%
0,052
domingo, 16 de maio de 2010
17
domingo, 16 de maio de 2010
18
Outcome Outcome + -
Risk
Odds
Intervention
10
90
10%
10%/90%
Control
20
80
20%
20%/80%
RR = OR = 0,5 0,4 domingo, 16 de maio de 2010
18
Outcome Outcome + -
Risk
Odds
Intervention
10
90
10%
10%/90%
Control
20
80
20%
20%/80%
RR = OR = 0,5 0,4 domingo, 16 de maio de 2010
18
Outcome Outcome + -
Risk
Odds
Intervention
10
90
10%
10%/90%
Control
20
80
20%
20%/80%
RR = OR = 0,5 0,4 domingo, 16 de maio de 2010
18
Outcome Outcome + Intervention
10
90
Risk
Odds
10%
10%/90%
RR = RA I/C
Control
20
80
20%
20%/80%
RR = OR = 0,5 0,4 domingo, 16 de maio de 2010
18
Outcome Outcome + Intervention
Control
10 20
90 80
Risk
Odds
10%
10%/90%
RR = RA I/C
OR = Odds I/C
20%
20%/80%
RR = OR = 0,5 0,4 domingo, 16 de maio de 2010
18
Outcome Outcome + Intervention
Control
10 20
90 80
Risk
Odds
10%
10%/90%
RR = RA I/C
OR = Odds I/C
20%
20%/80%
RR = OR = 0,5 0,4 domingo, 16 de maio de 2010
18
Measures of Effect Harzard Ratio
Intervention
Control
100
100
100
95
90
Survival (%)
80
75
70 70
50 50 40
25
35
30
30
0 2005 domingo, 16 de maio de 2010
2006
2007
2008
2009
2010 19
Measures of Effect Harzard Ratio
Intervention
Control
100
100
100
95
90
Survival (%)
80
75
70 70
50
RR = 5/30
50 40
25
35
30
30
0 2005 domingo, 16 de maio de 2010
2006
2007
2008
2009
2010 19
Measures of Effect Harzard Ratio
Intervention
Control
100
100
100
95
90
Survival (%)
80
75
70 70
50
0,17
50 40
25
35
30
30
0 2005 domingo, 16 de maio de 2010
2006
2007
2008
2009
2010 19
Measures of Effect Harzard Ratio
Intervention
Control
100
100
100
95
90
Survival (%)
80
75
70 70
50
0,17
50
RR = 10/50
25
40
35
30
30
0 2005 domingo, 16 de maio de 2010
2006
2007
2008
2009
2010 19
Measures of Effect Harzard Ratio
Intervention
Control
100
100
100
95
90
Survival (%)
80
75
70 70
50
0,17
50
0,2
25
40
35
30
30
0 2005 domingo, 16 de maio de 2010
2006
2007
2008
2009
2010 19
Measures of Effect Harzard Ratio
Intervention
Control
100
100
100
95
90
Survival (%)
80
75
70 70
50
0,17
50
0,2
25
0 2005 domingo, 16 de maio de 2010
2006
2007
40
RR = 20/60 2008
35
2009
30
30
2010 19
Measures of Effect Harzard Ratio
Intervention
Control
100
100
100
95
90
Survival (%)
80
75
70 70
50
0,17
50
0,2
25
40
35
0,33
30
30
0 2005 domingo, 16 de maio de 2010
2006
2007
2008
2009
2010 19
Measures of Effect Harzard Ratio
Intervention
Control
100
100
100
95
90
Survival (%)
80
75
70 70
50
0,17
50
0,2
25
40
0,33
0 2005 domingo, 16 de maio de 2010
2006
2007
2008
35
RR = 30/65 2009
30
30
2010 19
Measures of Effect Harzard Ratio
Intervention
Control
100
100
100
95
90
Survival (%)
80
75
70 70
50
0,17
50
0,2
25
40
0,33
0 2005 domingo, 16 de maio de 2010
2006
2007
2008
35
30
30
0,46 2009
2010 19
Measures of Effect Harzard Ratio
Intervention
Control
100
100
100
95
90
Survival (%)
80
75
70 70
50
0,17
50
0,2
25
40
0,33
0 2005 domingo, 16 de maio de 2010
2006
2007
2008
35
0,46 2009
30
30
RR = 70/70 2010 19
Measures of Effect Harzard Ratio
Intervention
Control
100
100
100
95
90
Survival (%)
80
75
70 70
50
0,17
50
0,2
25
40
0,33
0 2005 domingo, 16 de maio de 2010
2006
2007
2008
35
0,46 2009
30
30
1 2010 19
Measures of Effect Harzard Ratio 100
Control
HR ≃ Average RR ≃ 0,43
100
100
Intervention
95
90
Survival (%)
80
75
70 70
50
0,17
50
0,2
25
40
0,33
0 2005 domingo, 16 de maio de 2010
2006
2007
2008
35
0,46 2009
30
30
1 2010 19
Measures of Precision n resultados
Confidence Intervals ................ ............ 95% dos ......... valores f(x) ...... ! - 2"
-1,96
! 0
Estimate Effect ! + 2"
+1,96
Médias Medidas de Frequência Inferior Limit of 95% CI |
Medidas de Associação
| Superior Limit of 95% CI
Medidas de Impacto domingo, 16 de maio de 2010
20
Confidence Intervals 5 year mortality in the drug-eluting stents trials: All Sirius Sirius - Ravel Studies
RR (95% CI)
% Weight
All - Sirius
1,32(0,63-2,78)
48
Pache
1,40(0,45-4,35)
19,9
Ravel
1,72(0,75-3,95)
32,1
1,47 (0,89-241)
Overall 95% CI 0,23
1 RR
domingo, 16 de maio de 2010
4,35 Int J Epidemiol 2002;31:72-6. 21
Confidence Intervals 5 year mortality in the drug-eluting stents trials: All Sirius Sirius - Ravel RR (95% CI)
% Weight
1,32(0,63-2,78)
48
Pache
1,40(0,45-4,35)
19,9
Ravel
1,72(0,75-3,95)
32,1
Studies
All - Sirius
!
! - 2"
1,47 (0,89-241)
Overall 95% CI 0,23
1 RR
domingo, 16 de maio de 2010
! + 2"
4,35 Int J Epidemiol 2002;31:72-6. 21
Confidence Intervals 5 year mortality in the drug-eluting stents trials: All Sirius Sirius - Ravel Studies
All - Sirius
!
! - 2"
Pache
!
! - 2"
Ravel
1 RR
domingo, 16 de maio de 2010
! + 2"
% Weight
1,32(0,63-2,78)
48
1,40(0,45-4,35)
19,9
1,72(0,75-3,95)
32,1
1,47 (0,89-241)
Overall 95% CI 0,23
! + 2"
RR (95% CI)
4,35 Int J Epidemiol 2002;31:72-6. 21
Confidence Intervals 5 year mortality in the drug-eluting stents trials: All Sirius Sirius - Ravel Studies
All - Sirius
!
! - 2"
Pache
!
! - 2"
Ravel
! - 2"
1 RR
domingo, 16 de maio de 2010
! + 2"
!
! + 2"
% Weight
1,32(0,63-2,78)
48
1,40(0,45-4,35)
19,9
1,72(0,75-3,95)
32,1
1,47 (0,89-241)
Overall 95% CI 0,23
! + 2"
RR (95% CI)
4,35 Int J Epidemiol 2002;31:72-6. 21
Confidence Intervals 5 year mortality in the drug-eluting stents trials: All Sirius Sirius - Ravel Studies
All - Sirius
!
! - 2"
Pache
!
! - 2"
Ravel
! + 2"
!
! - 2"
Overall 95% CI 0,23
! - 2"
1 RR
domingo, 16 de maio de 2010
! + 2"
!
! + 2"
! + 2"
RR (95% CI)
% Weight
1,32(0,63-2,78)
48
1,40(0,45-4,35)
19,9
1,72(0,75-3,95)
32,1
1,47 (0,89-241) 4,35 Int J Epidemiol 2002;31:72-6. 21
domingo, 16 de maio de 2010
22
domingo, 16 de maio de 2010
23
Thank You! suzana.silva@procardiaco.com.br
domingo, 16 de maio de 2010
24