Making forest and funnel plots

Presented at the 30th Annual EACTS Meeting, Barcelona, Spain (1-5 October 2016)

Transcript

1. Meta-analysis from start to finish
   Graeme L. Hickey*
   Department of Biostatistics, University of Liverpool
   * No conflicts of interest
   

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3. Early all-cause mortality
   Five randomized trials
   

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4. TAVI SAVR
   Trial
   Year of
   publication
   Events, n Total, n Events, n Total, n
   NOTION 2015 3 139 5 135
   PARTNER 2011 12 348 22 351
   PARTNER 2A 2016 39 1011 41 1021
   STACCATO 2012 2 34 0 36
   US CoreValve 2014 13 390 16 357
   Outcome: early all-cause mortality
   

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5. Jones et al (39)
   Kobrin et al (40)
   Latib et al (12)
   Minutello et al (41)
   Muneretto et al (42)
   Onorati et al (43)
   Osnabrugge et al (13)
   Papadopoulos et al (44)
   Piazza et al (14)
   Santarpino et al (45)
   Schymik et al (15)
   Stöhr et al (46)
   Tamburino et al (16)
   Thakkar et al (47)
   Thongprayoon et al (48)
   Thourani et al (17)
   Walther et al (49)
   Wendt et al (50)
   Zweng et al (51)
   Random-effects model
   Heterogeneity: l2 = 39.3%; tau-squared = 0.1507; P = 0.017
   Random-effects model
   Heterogeneity: l2 = 37%; tau-squared = 0.1253; P = 0.0172
   Test for overall effect: P = 0.9041
   Test for subgroup differences: Q = 2.2; P = 0.1415
   0
   20
   2
   20
   20
   1
   2
   3
   33
   3
   3
   21
   20
   2
   3
   12
   10
   9
   2
   287
   356
   1.37 (0.68–2.77)
   1.00 (0.14–7.23)
   1.34 (0.79–2.30)
   2.23 (1.16–4.27)
   3.11 (0.12–79.64)
   0.65 (0.10–4.10)
   0.46 (0.11–1.98)
   1.35 (0.79–2.31)
   0.59 (0.14–2.53)
   0.32 (0.09–1.21)
   1.70 (0.82–3.51)
   0.83 (0.45–1.51)
   1.00 (0.13–7.60)
   1.51 (0.25–9.12)
   0.27 (0.14–0.52)
   0.63 (0.27–1.48)
   2.72 (0.69–10.63)
   1.00 (0.13–7.43)
   1.08 (0.84–1.38)
   1.01 (0.81–1.26)
   0.0
   4.8
   1.1
   6.1
   5.2
   0.4
   1.2
   1.8
   6.1
   1.8
   2.1
   4.6
   5.5
   1.0
   1.3
   5.1
   3.9
   2.0
   1.0
   81.7
   100
   0
   15
   2
   45
   19
   0
   3
   6
   25
   5
   9
   13
   24
   2
   2
   38
   15
   3
   2
   309
   393
   20
   194
   111
   595
   204
   28
   42
   40
   405
   102
   216
   175
   650
   30
   195
   1077
   100
   62
   44
   5657
   7579
   20
   194
   111
   1785
   408
   28
   42
   40
   405
   102
   216
   175
   650
   30
   195
   944
   100
   51
   44
   6907
   8807
   0.01 0.1 1 10 100
   Favors TAVI Favors SAVR
   Knapp–Hartung random-effects OR and 95% CI for 30-day all-cause mortality stratified by study design. NOTION = Nordic Aortic Valve Intervention;
   OR = odds ratio; PARTNER = Placement of Aortic Transcatheter Valves; SAVR = surgical aortic valve replacement; STACCATO = A Prospective,
   Randomised Trial of Transapical Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in Operable Elderly Patients With
   Aortic Stenosis; TAVI = transcatheter aortic valve implantation.
   * Percentages do not sum to 18.3% and 81.7% for randomized and matched studies, respectively, because of rounding.
   www.annals.org Annals of Internal Medicine • Vol. 165 No. 5 • 6 September 2016 337
   Downloaded From: http://annals.org/ by a University of Liverpool User on 09/21/2016
   Figure 1. Forest plot for early all-cause mortality in the overall population.
   Study (Reference)
   Randomized studies
   NOTION (9, 10)
   PARTNER (3–5)
   PARTNER 2A (11)
   STACCATO (26)
   U.S. CoreValve (6–8)
   Random-effects model
   Heterogeneity: l2 = 0%; tau-squared = 0; P = 0.4571
   Matched studies
   Ailawadi et al (27)
   Appel et al (28)
   Biancari et al (29)
   Conradi et al (30)
   D'Onofrio et al (31)
   Fusari et al (33)
   Guarracino et al (34)
   Hannan et al (35)
   Higgins et al (36)
   Holzhey et al (37)
   Johansson et al (38)
   Jones et al (39)
   Kobrin et al (40)
   Latib et al (12)
   Minutello et al (41)
   Muneretto et al (42)
   Onorati et al (43)
   Events, n
   3
   12
   39
   2
   13
   69
   34
   3
   10
   6
   2
   0
   3
   19
   6
   14
   4
   0
   20
   2
   20
   20
   1
   OR (95% CI)
   0.57 (0.13–2.45)
   0.53 (0.26–1.10)
   0.96 (0.61–1.50)
   5.62 (0.26–121.32)
   0.73 (0.35–1.55)
   0.80 (0.51–1.25)
   1.61 (0.92–2.81)
   1.54 (0.24–9.66)
   5.30 (1.14–24.63)
   0.85 (0.27–2.63)
   5.27 (0.24–113.60)
   0.19 (0.01–4.06)
   3.22 (0.32–32.89)
   1.00 (0.52–1.92)
   1.57 (0.41–6.00)
   0.76 (0.36–1.58)
   1.00 (0.23–4.31)
   1.37 (0.68–2.77)
   1.00 (0.14–7.23)
   1.34 (0.79–2.30)
   2.23 (1.16–4.27)
   3.11 (0.12–79.64)
   Weight (Random), %*
   1.8
   4.7
   6.9
   0.5
   4.5
   18.3
   5.9
   1.2
   1.6
   2.6
   0.5
   0.5
   0.8
   5.2
   2.1
   4.6
   1.8
   0.0
   4.8
   1.1
   6.1
   5.2
   0.4
   Events, n
   5
   22
   41
   0
   16
   84
   22
   2
   2
   7
   0
   2
   1
   19
   4
   18
   4
   0
   15
   2
   45
   19
   0
   Total, n
   139
   348
   1011
   34
   390
   1922
   340
   45
   144
   82
   38
   30
   30
   405
   46
   167
   40
   20
   194
   111
   595
   204
   28
   Total, n
   135
   351
   1021
   36
   357
   1900
   340
   45
   144
   82
   38
   30
   30
   405
   46
   167
   40
   20
   194
   111
   1785
   408
   28
   TAVI SAVR
   Systematic Review and Meta-analysis of TAVI Versus SAVR
   REVIEW
   NB. 31 observational studies have been deleted from the reported forest plot
   Heterogeneity statistics
   Labelled table of raw data
   Effect sizes &
   confidence intervals
   Weights
   Pooled
   estimate
   Direction labels
   Nicely formatted axes
   Forest plot with
   null line
   

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6. Systematic review
   Data extraction
   Software
   51 packages available
   for meta-analysis
   71 packages available
   for meta-analysis
   RevMan
   $$$
   

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7. + other software
   packages & online
   web calculators
   

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8. * Only for preparation of Cochrane Reviews or for purely academic use.
   

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13. 1 2 3
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    > Finish
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