ArticleEuropean heart journal2012
The win ratio: a new approach to the analysis of composite endpoints in clinical trials based on clinical priorities.
Article in European heart journal, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 8 registered trials, which are not on this map. Cited by 332 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
A Multicenter, Randomized, Double-Blind, Parallel Group, Placebo-Controlled Trial to Evaluate the Effect of In-Hospital Initiation of Dapagliflozin on Clinical Outcomes in Patients Who Have Been Stabilized During Hospitalization for Acute Heart Failure DAPAgliflozin and Effect on Cardiovascular Events in ACuTe Heart Failure -Thrombolysis in Myocardial Infarction 68 (DAPA ACT HF-TIMI 68)
Open the trial in the graphEfficacy and Safety of Treatment With Convalescent Plasma for Adults With COVID-19 Pneumonia. A Double-blinded, Randomized, Multicenter Placebo-controlled Trial
Endovascular Ablation of the Right Greater Splanchnic Nerve in Subjects Having Heart Failure With Preserved Ejection Fraction: Randomized Controlled Feasibility Trial - The Rebalance HF Study
Early Transcatheter Mitral Valve Repair After Myocardial Infarction
Early Left Ventricular unLoading by Impella (ECMELLA) or Intra-aortic Balloon Pump for Cardiogenic Shock in Patients on VA-ECMO
Minimal Invasive Scoliosis or Open Surgery
Endovascular Ablation Of The Right Greater Splanchnic Nerve In Subjects Having Heart Failure With Reduced Ejection Fraction: Randomized Controlled Feasibility Trial
Biological and Immunomodulatory Effect of Hemoadsorption With Macroporous Resin Cartridges in Septic Shock and Refractory Septic Shock Two Parallel Open-label Randomized Pilot Trials.
Who cites it
332 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- Pooled it
- Past Trends and Future Directions of Cardiac Regenerative Medicine - A Systematic Analysis of Clinical Trial Registries.Journal of cardiovascular translational research · 2025Pooled it
- The analysis and reporting of multiple outcomes in mental health trials: a methodological systematic review.BMC medical research methodology · 2024Pooled it
- Attrition and discontinuation in amyotrophic lateral sclerosis clinical trials: a meta-analysis.Journal of neurology · 2024Pooled it
- Composite outcome measures in high-impact critical care randomised controlled trials: a systematic review.Critical care (London, England) · 2024Pooled it
- Comparative effectiveness of torsemide vs furosemide in the management of heart failure patients: Win-ratio reanalysis of the TRANSFORM-HF trial.American heart journal · 2026Trial
- On Hierarchical Composite Endpoints in Pediatric Cancer Supportive Care: Illustrative Examples From Two Multi-Center Phase-III Randomized Clinical Trials.Pediatric blood & cancer · 2026Trial
- The ManageHF Just-in-Time Adaptive Mobile App Interventions to Promote Self-Management and Improve Outcomes in Heart Failure: Randomized Controlled Trial.JMIR mHealth and uHealth · 2026Trial
- Effect of intensive blood pressure and blood glucose control on cardiovascular outcomes driven by reductions in cardiovascular death and nephropathy: win ratio analysis of ADVANCE trial.European heart journal. Cardiovascular pharmacotherapy · 2026Trial
- Efficacy and Safety of Anselamimab in Immunoglobulin Light Chain Amyloidosis: Results From the Randomized CARES Trials.Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2026Trial
- Comprehensive clinical benefit of CCM in HFrEF patients: a win-ratio analysis of FIX-HF-5C randomized trial.ESC heart failure · 2026Trial
- Study design of the EDGEFIRM trial: transcatheter edge-to-edge repair versus guideline-directed medical therapy in atrial functional mitral regurgitation and HFpEF.ESC heart failure · 2026Trial
- Trial
- Hierarchical composite outcomes in acute ischaemic stroke with large infarct: a win ratio analysis of the TENSION trial.European stroke journal · 2026Trial
- Evaluating intensive blood pressure control versus usual care on cardiovascular disease in patients with diabetes using win statistics: a subgroup analysis of a cluster randomized trial.Journal of advanced research · 2026Trial
- A Remote Chronic Disease Management Program to Improve Cardiovascular and Metabolic Outcomes in a Diverse Community-Based Diabetic Population: Study Design of the TAMIS Trial.Journal of evaluation in clinical practice · 2026Trial
- A large randomized trial assessing alcohol cessation versus moderation on clinical events: UNATI.European journal of epidemiology · 2026Trial
- Cocoa flavanol supplementation and prevention of cardiovascular disease: a novel analysis of the COSMOS randomized trial using "win ratio".European journal of epidemiology · 2026Trial
- Suppression of microbial burden to reduce pneumonia in critical illness: the SMURF feasibility pilot study.Critical care (London, England) · 2026Trial
- Reexploring the STRESS Trial: Subgroup Postoperative Outcomes Following Methylprednisolone for Infant Heart Surgery.Pediatric cardiology · 2026Trial
272 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The conventional reporting of composite endpoints in clinical trials has an inherent limitation in that it emphasizes each patient's first event, which is often the outcome of lesser clinical importance. To overcome this problem, we introduce the concept of the win ratio for reporting composite endpoints. Patients in the new treatment and control groups are formed into matched pairs based on their risk profiles. Consider a primary composite endpoint, e.g. cardiovascular (CV) death and heart failure hospitalization (HF hosp) in heart failure trials. For each matched pair, the new treatment patient is labelled a 'winner' or a 'loser' depending on who had a CV death first. If that is not known, only then they are labelled a 'winner' or 'loser' depending on who had a HF hosp first. Otherwise they are considered tied. The win ratio is the total number of winners divided by the total numbers of losers. A 95% confidence interval and P-value for the win ratio are readily obtained. If formation of matched pairs is impractical then an alternative win ratio can be obtained by comparing all possible unmatched pairs. This method is illustrated by re-analyses of the EMPHASIS-HF, PARTNER B, and CHARM trials. The win ratio is a new method for reporting composite endpoints, which is easy to use and gives appropriate priority to the more clinically important event, e.g. mortality. We encourage its use in future trial reports.
Indexed as
Identifiers
21900289What Socratic holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.