Time to intervention during cardiac interventions. Are we forgetting a confounder?
As we evolve in the field of contemporary cardiothoracic surgery and witness modern applications of new techniques and technology, we need to be careful of how statistical methods are executed. Publications with hidden mediators that are not adequately addressed can lead to biased conclusions, especially when meta-analyzed. Public health policies need to be sure that their statements are as unbiased as possible for correct inference, leading to optimal patient safety and well-being. Careful analysis of hidden mediators is important in studies comparing the effectiveness of procedures and devices. Such analysis is critical in identifying mediators such as waiting time that should be considered when constructing interventions to be evaluated in the next RCT. In particular, RCTs of devices and procedures should always conduct (and report) ITT analysis, capturing all events from the time of randomization forward to control for differential waiting time. Similarly, observational registries and databases should count time zero as the time when patients are first referred for therapy, rather than when they enter a hospital to receive treatment; this would ensure that events during the waiting period are captured.
Shuhaiber
Jeffrey
J
Reston
James
J
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D015982:Bias; D015986:Confounding Factors, Epidemiologic; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003627:Data Interpretation, Statistical; D006331:Heart Diseases / Q000601:surgery / Q000628:therapy*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012042:Registries; D015203:Reproducibility of Results; D012107:Research Design; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists