A clinical dilemma: the longer the higher the risk?—Authors’ reply
Notice bibliographique
Résumé
We thank Babayiğit et al.1 for their interest in our work.2 We simulated 14-day Holter monitors using the heart rhythm profiles of patients with a newly implanted cardiac rhythm device who were enrolled in Asymptomatic Atrial Fibrillation and Stroke Evaluation in Pacemaker Patients and the Atrial Fibrillation Reduction Atrial Pacing Trial (ASSERT).2,3 We estimated that 3.1% of the study population would have more than 6 min of atrial fibrillation detected by a 14-day Holter and that these patients carried an annual risk of stroke of approximately 2.2%. Among ASSERT participants, approximately 95% had a pacemaker, and the remaining 5% had an implantable cardioverter defibrillator. The proportion of study participants with a history of heart failure was 14.5%. ASSERT participants were enrolled between 2004 and 2009, when semi-quantitative echocardiography was standard. Accordingly, the structural and functional heart characteristics of this population were not characterized to the degree they are in today’s practice. Moreover, medical therapy was different. The proportion of patients who were taking beta-blockers at study entry was 36.6%; many of our other modern medical therapies were not yet standard. The ultimate goal of atrial fibrillation screening is to prevent strokes in at-risk individuals.4 We live in an era where we have myriad tools to assist us in this pursuit. Our arsenal for detecting atrial fibrillation ranges from the timeless 12-lead electrocardiogram to implantable devices to direct-to-consumer technologies that can generate a surface electrocardiogram.5 There are emerging techniques and assays for quantifying individuals’ atrial fibrillation risk, including biomarkers, functional imaging, polygenic risk scores, and artificial intelligence. The challenge is to harness these technologies and deliver the right strategy for the right patients. Observational studies generate hypotheses that can be tested in appropriately designed randomized clinical trials. Our article generates the hypothesis that patients over the age of 65 with hypertension who have an atrial fibrillation burden of greater than 6 min on a 14-day screening Holter monitor will benefit from oral anticoagulation for prevention of ischaemic stroke. Randomized clinical trials can only test one hypothesis at a time. Currently, there are more than 15 published or ongoing randomized trials that are evaluating atrial fibrillation screening. These trials differ widely in the health care settings in which they are conducted, the participants they enrol, and the modalities that are employed to detect and define atrial fibrillation. Two large, international, and co-operating consortia [AF-SCREEN (https://www.afscreen.org/) and AFFECT-EU (http://affect-eu.eu/)] have been working to systematically record and co-ordinate efforts in atrial fibrillation screening research. Among the ongoing initiatives is a prospectively planned individual participant data meta-analysis. This project is designed to offer the power to evaluate stroke as an outcome and to explore the population, screening modality, and health system factors that contribute to successful screening programmes. The primary results of ASSERT were published 10 years ago, when our understanding of atrial fibrillation was simpler and our technologies vastly more limited. However, the uniqueness of a large data set of continuously monitored patients with minimal (<2%) use of oral anticoagulation continues to advance theories that can be tested in the modern research arena. Conflict of interest: None declared.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,006 | 0,071 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,002 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,005 | 0,005 |
| Communication savante | 0,008 | 0,006 |
| Science ouverte | 0,002 | 0,003 |
| Intégrité de la recherche | 0,090 | 0,070 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,008 | 0,007 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».