%0 Journal Article %1 Delaney2009 %A Delaney, Joseph A C %A Daskalopoulou, Stella S %A Suissa, Samy %D 2009 %J Pharmacoepidemiology and drug safety %K 80andover Adrenergicbeta-Antagonists Adrenergicbeta-Antagonists:therapeuticuse Aged BloodPressure BloodPressure:drugeffects CohortStudies Databases Factual Female Follow-UpStudies GreatBritain Humans LogisticModels Male MiddleAged Models MyocardialInfarction MyocardialInfarction:drugtherapy MyocardialInfarction:mortality Statistical SurvivalAnalysis TreatmentOutcome RCT %N 1 %P 1-6 %R 10.1002/pds.1676 %T Traditional versus marginal structural models to estimate the effectiveness of beta-blocker use on mortality after myocardial infarction. %U http://www.ncbi.nlm.nih.gov/pubmed/18949804 %V 18 %X BACKGROUND: Observational studies of the effect of beta-blockers on all-cause mortality after an acute myocardial infarction (AMI) have tended to overestimate the effectiveness of this treatment. OBJECTIVE: To compare the estimates of the effect of beta-blocker use on mortality post-AMI derived from a traditional adjusted regression model with those from a marginal structural model. METHODS: A population-based cohort spanning the period of 2002-2004 was formed from the United Kingdom General Practice Research Database (GPRD). The cohort included all subjects who survived 90 days after their first AMI, who were then followed for 9 months. beta-Blocker use and blood pressure were identified in both the 90-day period before and the 90-day period after the AMI. Rate ratios (RR) were estimated using pooled logistic regression. RESULTS: The cohort included 9939 participants who survived 90 days after their AMI, of whom 633 died during the 9-month follow-up. Over 23% were taking beta-blockers pre-AMI, compared with 71% post-AMI. Using the traditional adjusted regression analysis, the RR of death with post-AMI beta-blocker use was 0.54 (95% confidence interval (CI): 0.45-0.67), while using the inverse probability of treatment weighting (IPTW) model it was 0.72 (95%CI: 0.61-0.84). The IPTW estimate is compatible with the estimate derived from a meta-analysis of randomized controlled trials (RCTs) while the adjusted regression estimate exaggerates the effectiveness. CONCLUSIONS: Observational studies of the association of anti-hypertensive medications with all-cause mortality should consider adding a marginal structural model to their armamentarium of data analysis. %@ 1099-1557

@article{Delaney2009, abstract = {BACKGROUND: Observational studies of the effect of beta-blockers on all-cause mortality after an acute myocardial infarction (AMI) have tended to overestimate the effectiveness of this treatment. OBJECTIVE: To compare the estimates of the effect of beta-blocker use on mortality post-AMI derived from a traditional adjusted regression model with those from a marginal structural model. METHODS: A population-based cohort spanning the period of 2002-2004 was formed from the United Kingdom General Practice Research Database (GPRD). The cohort included all subjects who survived 90 days after their first AMI, who were then followed for 9 months. beta-Blocker use and blood pressure were identified in both the 90-day period before and the 90-day period after the AMI. Rate ratios (RR) were estimated using pooled logistic regression. RESULTS: The cohort included 9939 participants who survived 90 days after their AMI, of whom 633 died during the 9-month follow-up. Over 23% were taking beta-blockers pre-AMI, compared with 71% post-AMI. Using the traditional adjusted regression analysis, the RR of death with post-AMI beta-blocker use was 0.54 (95% confidence interval (CI): 0.45-0.67), while using the inverse probability of treatment weighting (IPTW) model it was 0.72 (95%CI: 0.61-0.84). The IPTW estimate is compatible with the estimate derived from a meta-analysis of randomized controlled trials (RCTs) while the adjusted regression estimate exaggerates the effectiveness. CONCLUSIONS: Observational studies of the association of anti-hypertensive medications with all-cause mortality should consider adding a marginal structural model to their armamentarium of data analysis.}, added-at = {2023-02-03T11:44:35.000+0100}, author = {Delaney, Joseph A C and Daskalopoulou, Stella S and Suissa, Samy}, biburl = {https://www.bibsonomy.org/bibtex/2c28ddf722ca83a144a854bb7d3abab51/jepcastel}, city = {Department of Biostatistics, Collaborative Health Studies Coordinating Center, University of Washington, Seattle, WA 98115 USA. jacd@u.washington.edu}, doi = {10.1002/pds.1676}, interhash = {3504f5875c994170768ab8fe30174b64}, intrahash = {c28ddf722ca83a144a854bb7d3abab51}, isbn = {1099-1557}, issn = {1099-1557}, journal = {Pharmacoepidemiology and drug safety}, keywords = {80andover Adrenergicbeta-Antagonists Adrenergicbeta-Antagonists:therapeuticuse Aged BloodPressure BloodPressure:drugeffects CohortStudies Databases Factual Female Follow-UpStudies GreatBritain Humans LogisticModels Male MiddleAged Models MyocardialInfarction MyocardialInfarction:drugtherapy MyocardialInfarction:mortality Statistical SurvivalAnalysis TreatmentOutcome RCT}, month = {1}, note = {5076<m:linebreak></m:linebreak>JID: 9208369; 0 (Adrenergic beta-Antagonists); ppublish;<m:linebreak></m:linebreak>Anàlisi de dades; Marginal structural models; Exemple}, number = 1, pages = {1-6}, pmid = {18949804}, timestamp = {2023-05-04T08:59:38.000+0200}, title = {Traditional versus marginal structural models to estimate the effectiveness of beta-blocker use on mortality after myocardial infarction.}, url = {http://www.ncbi.nlm.nih.gov/pubmed/18949804}, volume = 18, year = 2009 }