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
3. Early all-cause mortality Five randomized trials
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
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
6. Systematic review Data extraction Software 51 packages available for meta-analysis 71 packages available for meta-analysis RevMan $$$
7. + other software packages & online web calculators
8. * Only for preparation of Cochrane Reviews or for purely academic use.
13. 1 2 3 5 4 > Finish 6