Cumulative meta-analyses of myocardial infarction trials showed that expert recommendations often delayed endorsing effective therapies or continued recommending ineffective ones.
Meta-Analysis
Are there discrepancies between the results of cumulative meta-analyses of RCTs and the recommendations of clinical experts for myocardial infarction treatments?
Cumulative meta-analysis reveals significant delays and discrepancies between accumulating RCT evidence and expert recommendations for myocardial infarction treatments.
OBJECTIVE: To examine the temporal relationship between accumulating data from randomized control trials of treatments for myocardial infarction and the recommendations of clinical experts writing review articles and textbook chapters. DATA SOURCES: (1) MEDLINE search from 1966 to present; search terms used were myocardial infarction, clinical trials, multicenter studies, double-blind method, meta-analysis, and the text word "random:"; (2) references from pertinent articles and books; and (3) all editions of English-language general medical texts and manuals and review articles on treatment of myocardial infarction. STUDY SELECTION: Randomized control trials of therapies for reducing the risk of total mortality in myocardial infarction (acute and secondary prevention). Review articles and textbook chapters dealing with the general clinical management of patients with myocardial infarction. DATA EXTRACTION: Two authors read the material and recorded the results; disagreements were resolved by conference. DATA SYNTHESIS: We used the technique of cumulative meta-analysis (performing a new meta-analysis when the results of a new clinical trial are published) and compared the results with the recommendations of the experts for various treatments for myocardial infarction. Discrepancies were detected between the meta-analytic patterns of effectiveness in the randomized trials and the recommendations of reviewers. Review articles often failed to mention important advances or exhibited delays in recommending effective preventive measures. In some cases, treatments that have no effect on mortality or are potentially harmful continued to be recommended by several clinical experts. CONCLUSIONS: Finding and analyzing all therapeutic trials in a given field has become such a difficult and specialized task that the clinical experts called on to summarize the evidence in a timely fashion need access to better databases and new statistical techniques to assist them in this important task.
Elliott M. Antman (1992) conducted a meta-analysis in Myocardial infarction. Various treatments for myocardial infarction vs. Recommendations of clinical experts was evaluated on Temporal relationship between accumulating RCT data and clinical expert recommendations. Cumulative meta-analyses of myocardial infarction trials showed that expert recommendations often delayed endorsing effective therapies or continued recommending ineffective ones.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: