Results

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