title: Effect of warfarin on survival in scleroderma-associated pulmonary arterial hypertension (SSc-PAH) and idiopathic PAH. Belief elicitation for Bayesian priors.
abstract: OBJECTIVE
  Warfarin use in scleroderma (SSc)-associated pulmonary arterial hypertension (PAH) and idiopathic PAH (IPAH) is controversial. A prerequisite for a trial is the demonstration of community uncertainty. We evaluated experts' beliefs about the effect of warfarin on 3-year survival in SSc-PAH and IPAH, and factors that influence warfarin use.
  
  
  METHODS
  PAH experts attending the 2008 American College of Rheumatology or American Thoracic Society meetings expressed the probability of 3-year survival without and with warfarin and their degree of uncertainty by applying adhesive dots, each representing a 5% weight of probability, in "bins" on a line, creating a prior probability distribution or prior. Using a numeric rating scale, participants rated factors that influence their use of warfarin.
  
  
  RESULTS
  Forty-five experts (44% pulmonologists, 38% rheumatologists, 16% cardiologists, 2% internists) underwent the belief elicitation interview. In SSc-PAH, the mean probabilities of 3-year survival without and with warfarin were 54% and 56%, respectively. Pessimistic experts believe that warfarin worsens survival by 7%. Optimistic experts believe that warfarin improves survival by 13%. In IPAH, the mean probabilities of 3-year survival without and with warfarin were 68% and 76%. Factors (mean rating out of 10, 0 = not at all important, 10 = extremely important) that influence experts' use of warfarin were functional class (5.4), age (5.4), pulmonary artery pressure (5.2), peripheral vascular disease (3.6), disease duration (2.8), and sex (1.7).
  
  
  CONCLUSIONS
  Bayesian priors effectively quantify and illustrate experts' beliefs about the effect of warfarin on survival in SSc-PAH and IPAH. This study demonstrates the presence of uncertainty about the effect of warfarin, and provides justification for a clinical trial.
authors.affiliation: Division of Rheumatology, Toronto Western Hospital, Toronto, Ontario M5T 2S8, Canada. Sindhu.Johnson@uhn.on.ca
authors.forename: Sindhu R
authors.initials: SR
authors.lastname: Johnson
authors.forename: John T
authors.initials: JT
authors.lastname: Granton
authors.forename: George A
authors.initials: GA
authors.lastname: Tomlinson
authors.forename: Haddas A
authors.initials: HA
authors.lastname: Grosbein
authors.forename: Gillian A
authors.initials: GA
authors.lastname: Hawker
authors.forename: Brian M
authors.initials: BM
authors.lastname: Feldman
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D001499:Bayes Theorem; D065627:Familial Primary Pulmonary Hypertension; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy / Q000209:etiology / Q000401:mortality; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012595:Scleroderma, Systemic / Q000150:complications*; D011795:Surveys and Questionnaires; D015996:Survival Rate; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin