Trial reportCirculation. Heart failure2015

Association Between Use of Statins and Mortality in Patients With Heart Failure and Ejection Fraction of ≥50.

Urban Alehagen, Lina Benson, Magnus Edner, Ulf Dahlström, Lars H Lund

Abstract readMulticenter StudyRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in Circulation. Heart failure, 2015. The graph read 3 numbers from its abstract, feeding 2 cells of the map: it favours the comparator in 1. It also reports 2 associations that do not count as treatment evidence, such as HR 0.89 (0.82 to 0.96) for cardiovascular events. Cited by 54 papers, 1 of them a synthesis that pooled it.

3numbers the graph read from it
1cell of the map it votes in
54citing papers in PubMed, 1 pooled it
9.7field-weighted citation impact, top 1% of its field
1 · What the graph read from 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.

← favours the comparatorfavours the treatment →
1 · no effect
All-cause mortalityfavours the comparator · against placebo · heart_failure, ascvdfeeds one cell of the map
HR 0.800.72 to 0.89P<0.001
In the matched population, 1-year survival was 85.1% for statin-treated versus 80.9% for untreated patients (hazard ratio, 0.80; 95% confidence interval, 0.72-0.89; P<0.001).

Read, but not usablea number the graph found but could not read as for or against

Cardiovascular eventsan association or prognostic statement, not a treatment comparison · heart_failure, ascvdfeeds one cell of the map
HR 0.890.82 to 0.96P=0.003
Statins were also associated with reduced cardiovascular death (hazard ratio, 0.86; 95% confidence interval, 0.75-0.98; P=0.026) and composite all-cause mortality or cardiovascular hospitalization (hazard ratio, 0.89; 95% confidence interval, 0.82-0.96; P=0.003).
Cardiovascular eventsan association or prognostic statement, not a treatment comparison · heart_failure, ascvdfeeds one cell of the map
HR 0.860.75 to 0.98P=0.026
Statins were also associated with reduced cardiovascular death (hazard ratio, 0.86; 95% confidence interval, 0.75-0.98; P=0.026) and composite all-cause mortality or cardiovascular hospitalization (hazard ratio, 0.89; 95% confidence interval, 0.82-0.96; P=0.003).

clause the extractor read what became the number

2 · Its place on the map

Where it lands on the map

Rows are treatments, columns are outcomes. The coloured squares are the cells this paper feeds, coloured by the vote it casts there. Click one to jump to what this paper adds to it.

supports the treatmentfavours the comparatorno clear differenceread, but no usable result
3 · What it changes

What it adds to each cell

For every cell the paper feeds: the belief in the claim with and without this paper, and this paper's estimate drawn against every other readable study in the cell. The ringed dot is this paper.

Statins×all-cause mortality

ContradictsOpen on the map →What to test next →

14 readable studies in this cell: 3 favour the treatment, 9 find no difference, 2 favour the comparator.

Belief with this paper
0.50contested · 3 families support, 2 contradict · against placebo
Without it
0.50This paper does not move the number.
← favours the comparatorfavours the treatment →
1 · no effect
This paper · 2015
HR 0.800.72 to 0.89
NCT023442907,769 enrolled · 2015
HR 0.880.70 to 1.12
HR 1.010.91 to 1.11
NCT03944512102 enrolled · 2019
RR 0.670.37 to 1.19
RR 0.990.89 to 1.11

Statins×cardiovascular events

No readable resultOpen on the map →What to test next →

30 readable studies in this cell: 18 favour the treatment, 11 find no difference, 1 favour the comparator.

Belief with this paper
0.86replicated · 12 families support, 2 contradict · against placebo
Without itNot a counted family in this claim, so removing it changes nothing.
← favours the treatmentfavours the comparator →
1 · no effect
HR 0.710.56 to 0.90
NCT023442907,769 enrolled · 2015
HR 0.640.48 to 0.84
HR 1.781.00 to 3.17
NCT03944512102 enrolled · 2019
RR 0.670.37 to 1.19

This paper's own estimate is on a different scale from the rest of the cell, so it is not drawn here.

4 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

5 · Its place in the literature

Who cites it

54 citing papers in PubMed, 1 synthesis or guideline pooled it, 107 citations in OpenAlex.

  1. Pooled it
  2. Trial
  3. Trial
  4. Article
  5. Review
  6. Review
  7. Review
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  12. Review
  13. Article
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  15. Article
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  17. Observational
  18. Review
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6 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

7 · Who and what money

Authors and funding

5 authors at 1 institution in 1 country.

Urban AlehagenFrom the Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden (U.A., U.D.); Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden (L.B.); and Department of Cardiology, Karolinska University Hospital and Department of Medicine, Unit of Cardiology, Karolinska Institutet, Stockholm, Sweden (M.E., L.H.L.). urban.alehagen@liu.se.
Lina BensonFrom the Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden (U.A., U.D.); Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden (L.B.); and Department of Cardiology, Karolinska University Hospital and Department of Medicine, Unit of Cardiology, Karolinska Institutet, Stockholm, Sweden (M.E., L.H.L.).
Magnus EdnerFrom the Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden (U.A., U.D.); Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden (L.B.); and Department of Cardiology, Karolinska University Hospital and Department of Medicine, Unit of Cardiology, Karolinska Institutet, Stockholm, Sweden (M.E., L.H.L.).
Ulf DahlströmFrom the Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden (U.A., U.D.); Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden (L.B.); and Department of Cardiology, Karolinska University Hospital and Department of Medicine, Unit of Cardiology, Karolinska Institutet, Stockholm, Sweden (M.E., L.H.L.).
Lars H LundFrom the Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden (U.A., U.D.); Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden (L.B.); and Department of Cardiology, Karolinska University Hospital and Department of Medicine, Unit of Cardiology, Karolinska Institutet, Stockholm, Sweden (M.E., L.H.L.).
Karolinska Institutet · SE

Funding

No grant is acknowledged in the PubMed record.

8 · The paper itself

Abstract

The marked sentences are the ones the graph read a number from.

backgroundThe pathophysiology of heart failure with preserved ejection fraction is poorly understood, but may involve a systemic proinflammatory state. Therefore, statins might improve outcomes in patients with heart failure with preserved ejection fraction defined as ≥50%. METHODS AND

resultsOf 46 959 unique patients in the prospective Swedish Heart Failure Registry, 9140 patients had heart failure and ejection fraction ≥50% (age 77±11 years, 54.0% women), and of these, 3427 (37.5%) were treated with statins. Propensity scores for statin treatment were derived from 40 baseline variables. The association between statin use and primary (all-cause mortality) and secondary (separately, cardiovascular mortality, and combined all-cause mortality or cardiovascular hospitalization) end points was assessed with Cox regressions in a population matched 1:1 based on age and propensity score. In the matched population, 1-year survival was 85.1% for statin-treated versus 80.9% for untreated patients (hazard ratio, 0.80; 95% confidence interval, 0.72-0.89; P<0.001). Statins were also associated with reduced cardiovascular death (hazard ratio, 0.86; 95% confidence interval, 0.75-0.98; P=0.026) and composite all-cause mortality or cardiovascular hospitalization (hazard ratio, 0.89; 95% confidence interval, 0.82-0.96; P=0.003).

conclusionsIn heart failure with ejection fraction ≥50%, the use of statins was associated with improved outcomes. The mechanisms should be evaluated and the effects tested in a randomized trial.

Indexed as

AgedCause of DeathFemaleFollow-Up StudiesHeart FailureHumansHydroxymethylglutaryl-CoA Reductase InhibitorsMalePropensity ScoreRetrospective StudiesRisk AssessmentStroke VolumeSurvival RateSwedenHydroxymethylglutaryl-CoA Reductase Inhibitorsheart failureheart failure with preserved ejection fractionmortalitypropensity scorestatin intervention

Identifiers

PMID26243795
OpenAlexW2176770752

What Socratic holds

Texttitle and abstract
Read underepoch 390

Registered trials

None linked

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.