A Bayesian Interpretation of CABANA and Other Randomized Controlled Trials for Catheter Ablation in Patients With Atrial Fibrillation.
Background: Catheter ablation improves symptoms and quality of life in atrial fibrillation patients, but its effect on adverse cardiovascular outcomes and mortality remains uncertain. Bayesian analysis of randomized controlled trials offers a deeper understanding of treatment effects beyond conventi...
| Publicado en: | Journal of Cardiovascular Electrophysiology Vol. 36; no. 3; pp. 617 - 625 |
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| Autores principales: | , , , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Wiley-Blackwell
Mar2025
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=183627026&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 183627026 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10453873 GSB jtl: Journal of Cardiovascular Electrophysiology issn: 10453873 maglogo: Y pubinfo: dt: Mar2025 vid: 36 iid: 3 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 183627026 183627026 183627026 10.1111/jce.16552 183627026 ppf: 617 ppct: 8 formats: fmt: – @attributes: type: T – @attributes: type: C – @attributes: type: P tig: atl: A Bayesian Interpretation of CABANA and Other Randomized Controlled Trials for Catheter Ablation in Patients With Atrial Fibrillation. aug: au: Nogueira, Alleh Felix, Nicole Kalil, Felipe Tramujas, Lucas Godoi, Amanda Miyawaki, Isabele A. Bellavia, Andrea Moura, Filipe A. Cardoso, Rhanderson d'Avila, André Fernandes, Gilson C. affil: Department of Medicine, Escola Bahiana de Medicina e Saúde Pública, Salvador Bahia,, Brazil sug: subj: Atrial Fibrillation Therapy Catheter Ablation Methods Antiarrhythmia Agents Therapeutic Use Randomized Controlled Trials Human Descriptive Statistics Data Analysis Software Confidence Intervals Odds Ratio Models, Statistical Post Hoc Analysis Atrial Fibrillation Prevention and Control Quality of Life Catheter Ablation Adverse Effects Mortality Risk Factors Male Female Adult Middle Age Adult: 19-44 years Middle Aged: 45-64 years Male Female ab: Background: Catheter ablation improves symptoms and quality of life in atrial fibrillation patients, but its effect on adverse cardiovascular outcomes and mortality remains uncertain. Bayesian analysis of randomized controlled trials offers a deeper understanding of treatment effects beyond conventional p‐value thresholds. Methods: We conducted a post hoc Bayesian reanalysis of CABANA and four similar trials to estimate catheter ablation's effect on cardiovascular and survival outcomes. Using publicly available, trial‐level data, we fitted ordinal Bayesian regression models to assess the impact of catheter ablation on the primary composite outcome—comprising all‐cause mortality, stroke with disability, serious bleeding, and cardiac arrest—as well as mortality alone. We considered two sets of prior distributions: (1) a noninformative prior, where all effect sizes are equally probable and inference is primarily based on trial data, and (2) a treatment effect distribution derived from four trials using a random effects model. Results: In this analysis, refined probability distributions for treatment effects were obtained by integrating data from CABANA with diverse priors through Bayes' theorem, offering a novel, nuanced probabilistic understanding of the potential impact of ablation compared with medical therapy on cardiovascular outcomes and all‐cause mortality. In contrast to CABANA's original frequentist estimates, which were inconclusive, Bayesian analyses indicated probabilities of 82.6% and 81.1% that ablation is superior in reducing adverse cardiovascular outcomes and mortality, respectively. Incorporating results from four other similar trials increased the probability of improved effects on mortality to 86.0%. Conclusions: Bayesian analysis augmented the interpretation of previously inconclusive findings, suggesting a clinically relevant probability of benefit from catheter ablation compared to medical therapy in a broad population with atrial fibrillation. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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