Weniger Erwerbsminderungsrenten nach der kardiologischen Rehabilitation durch intensivierte Nachsorge?

2021 ◽  
Author(s):  
Sarah Schröer ◽  
Wolfgang Mayer-Berger ◽  
Claudia Pieper
Keyword(s):  
Fixed Effects ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Patient Data ◽  
Odds Ratios ◽  
Two Stage ◽  
Kardiologische Rehabilitation ◽  
One Stage

Zusammenfassung Ziel Ziel war es die Daten aus 3 randomisierten kontrollierten Studien, in denen Nachsorgekonzepte im Rahmen der kardiologischen Rehabilitation evaluiert wurden, in Form einer Pooling-Studie zusammenzufassen, um stärker belastbare Erkenntnisse über den nachsorgeassoziierten weiteren Verlauf der Patienten und Patientinnen im Anschluss an die Rehabilitation zu gewinnen. Nachfolgend werden die Auswirkungen von poststationärer Nachsorge auf das Erwerbsminderungsrisiko kardiologischer Rehabilitanden und Rehabilitandinnen vorgestellt. Methodik Aus 3 randomisierten kontrollierten Primärstudien (SeKoNa, Sinko, OptiHyp), in denen als Intervention jeweils ein intensiviertes (telefongestütztes) poststationäres Nachsorgekonzept mit einer unbehandelten Kontrollgruppe verglichen wurde, stehen umfangreiche Daten zu soziodemografischen, klinischen und diagnostischen Charakteristika auf Individualebene zur Verfügung. Mittels einer im August 2019 durchgeführten Sekundärdatenanalyse von Routinedaten der Deutschen Rentenversicherung Rheinland wurden als primäre Outcomeparameter Mortalität (alle Ursachen), bewilligte Erwerbsminderungsrenten sowie bewilligte Anträge auf eine erneute kardiologische Rehabilitation zum individuellen Stichtag 3 Jahre nach Rehabilitationsende als Endpunkte erhoben. Die Daten wurden als Meta-Analyse für individuelle Patientendaten (Individual Patient Data Meta-Analysis IPD-MA) unter Verwendung klassischer meta-analytischer Techniken (One-Stage Approach mittels gemischter Modelle und Two-Stage Approach mit inverser Varianzschätzung als Fixed Effects Modell) gepoolt und über Risiko-Odds-Ratios vergleichend ausgewertet. Ergebnisse Das Gesamtkollektiv besteht aus insgesamt 1058 kardiologischen Rehabilitanden und Rehabilitandinnen, die im Zeitraum zwischen 2004 und 2015 stationäre rehabilitative Leistungen der Deutschen Rentenversicherung Rheinland in der kardiologischen Rehabilitationseinrichtung Klinik Roderbirken in Leichlingen in Anspruch genommen haben. Die gepoolte Interventionsgruppe (poststationäre Nachsorge) und die gepoolte Kontrollgruppe (Standardbehandlung) unterschieden sich zum Ausgangspunkt (Entlassung nach 3-wöchiger Rehabilitation) nicht. Hinweise auf statistische Heterogenität liegt nicht vor. Drei Jahre nach Rehabilitationsende betrug die inzidente Erwerbsminderungsrentenquote 11,8% der Gesamtstichprobe. Bei Teilnahme an einem poststationären Nachsorgekonzept war das Erwerbsminderungsrisiko gegenüber der Kontrollgruppe um rund 60% reduziert (OR: 0,43; 95% CI: 0,36–0,51). Schlussfolgerung Rehabilitation und Wiedereingliederung gewinnen weiter an Bedeutung, um die Gefahr von gesundheitlich bedingten vorzeitigen Erwerbsausstiegen mit erheblichen sozioökonomischen Folgen für Betroffene und das Sozialversicherungssystem zu vermeiden. Nachsorgeaktivitäten, die Rehabilitationserfolge über Dauer einer mehrwöchigen Rehabilitation hinaus erhalten, unterstützen die Prävention von gesundheitlich bedingten vorzeitigen Erwerbsminderungsrenten effektiv und nachhaltig und sollten das bestehende Rehabilitationsangebot komplettieren. Aus unseren Ergebnissen folgern wir, dass Nachsorge lange genug (mindestens ein Jahr) und im persönlichen Kontakt erfolgen muss.

Empirical comparison of subgroup effects in conventional and individual patient data meta-analyses

2008 ◽  
Vol 24 (03) ◽  
pp. 358-361 ◽  
Author(s):  
Laura Koopman ◽  
Geert J. M. G. van der Heijden ◽  
Arno W. Hoes ◽  
Diederick E. Grobbee ◽  
Maroeska M. Rovers
Keyword(s):  
Individual Patient Data ◽  
Meta Analysis ◽  
Acute Otitis Media ◽  
Patient Data ◽  
Published Data ◽  
Summary Statistics ◽  
Two Stage ◽  
Data Set ◽  
Meta Analyses ◽  
Subgroup Effects

Objectives:Individual patient data (IPD) meta-analyses have been proposed as a major improvement in meta-analytic methods to study subgroup effects. Subgroup effects of conventional and IPD meta-analyses using identical data have not been compared. Our objective is to compare such subgroup effects using the data of six trials (n= 1,643) on the effectiveness of antibiotics in children with acute otitis media (AOM).Methods:Effects (relative risks, risk differences [RD], and their confidence intervals [CI]) of antibiotics in subgroups of children with AOM resulting from (i) conventional meta-analysis using summary statistics derived from published data (CMA), (ii) two-stage approach to IPD meta-analysis using summary statistics derived from IPD (IPDMA-2), and (iii) one-stage approach to IPD meta-analysis where IPD is pooled into a single data set (IPDMA-1) were compared.Results:In the conventional meta-analysis, only two of the six studies were included, because only these reported on relevant subgroup effects. The conventional meta-analysis showed larger (age < 2 years) or smaller (age ≥ 2 years) subgroup effects and wider CIs than both IPD meta-analyses (age < 2 years: RDCMA-21 percent, RDIPDMA-1-16 percent, RDIPDMA-2-15 percent; age ≥2 years: RDCMA-5 percent, RDIPDMA-1-11 percent, RDIPDMA-2-11 percent). The most important reason for these discrepant results is that the two studies included in the conventional meta-analysis reported outcomes that were different both from each other and from the IPD meta-analyses.Conclusions:This empirical example shows that conventional meta-analyses do not allow proper subgroup analyses, whereas IPD meta-analyses produce more accurate subgroup effects. We also found no differences between the one- and two-stage meta-analytic approaches.

Abstract WP410: Hemoglobin Levels and Poor Outcome in Intracerebral Hemorrhage: An Exploratory Analysis of Individual Patient Data Across Multiple Studies

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Julian N Acosta ◽  
Audrey C Leasure ◽  
Lindsey Kuohn ◽  
Nils Petersen ◽  
Lauren Sansing ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Intracerebral Hemorrhage ◽  
Fixed Effects ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Outcome Data ◽  
Patient Data ◽  
Multicenter Studies ◽  
Poor Outcome ◽  
Ich Score

Introduction: Observational evidence from single center studies indicates that lower admission hemoglobin (Hb) levels are associated with poor outcome after spontaneous intracerebral hemorrhage (ICH). We combined data from three multicenter studies to test the hypothesis that Hb levels inversely correlate with functional outcome in ICH. Methods: We conducted a meta-analysis of individual patient data from the clinical trials ATACH-II and FAST and the multi-ethnic study ERICH. We included participants with available Hb and outcome data. We used multivariable logistic regression to test for association between admission Hb levels and 3-month dichotomized (0-3 versus 4-6) modified Rankin Scale (mRS), adjusting for the variables contained in the ICH score. We pooled study-specific estimates using inverse-variance weighted, fixed effects meta-analysis. Results: A total of 4106 ICH patients were included in the analysis. Each additional g/dL of admission Hb was associated with a 12% (OR 0.88, 95%CI 0.85-0.91; p<0.001) and 8% (OR 0.92, 95%CI 0.88-0.96; p<0.001) reduction in the odds of poor outcome in unadjusted and adjusted analyses, respectively (Table 1). Dose-response analyses indicated a linear relationship between Hb levels and poor outcome across the entire evaluated range (Figure 1, test-for-trend p<0.001). In metanalysis, there were not significant associations between Hb and ICH volume or expansion (both p>0.05). Conclusion: Lower hemoglobin levels are associated with poor outcome in ICH. Further studies of the underlying biological mechanisms are warranted. If replicated, this pathway could become an appealing target to be tested in clinical trials.

scholarly journals Meta-analysis of Gaussian individual patient data: Two-stage or not two-stage?

2018 ◽  
Vol 37 (9) ◽  
pp. 1419-1438 ◽  
Author(s):  
Tim P. Morris ◽  
David J. Fisher ◽  
Michael G. Kenward ◽  
James R. Carpenter
Keyword(s):  
Individual Patient Data ◽  
Meta Analysis ◽  
Patient Data ◽  
Two Stage

scholarly journals Integrating Aggregate-Data and Individual-Patient-Data in Meta-Analysis: An Empirical Assessment and an Alternative Method for the Two-Stage Approach

2015 ◽  
Vol 9 (13) ◽  
pp. 237
Author(s):  
Nik Ruzni Nik Idris ◽  
Nurul Afiqah Misran
Keyword(s):  
Root Mean Square Error ◽  
Coverage Probability ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Current Method ◽  
Patient Data ◽  
Aggregate Data ◽  
Mean Square ◽  
Two Stage ◽  
Overall Efficiency

In this study, we compared the efficacy of the overall meta-analysis estimates that used only the available aggregate data (AD) studies against those that combined the available AD and individual patient data (IPD) studies. We introduced some modifications to the existing two-stage method for combining the AD and IPD studies. We evaluated the effects of these modifications on the estimates of the overall treatment effect, and investigated the influence of the number of studies included in the meta-analysis, N, and the ratio of AD: IPD on these estimates. We used percentage relative bias (PRB), root mean-square-error (RMSE), and coverage probability to assess the overall efficiency of these estimates. The results revealed the superiority of estimates from the combined AD: IPD studies over those that utilized only the available AD in terms of both the accuracy and the RMSE. We found that the current method for combining the AD:IPD studies provided poor coverage probabilityand that the proposed methods generated improved coverage probability by more than 40% while maintaining the level of bias and RMSE at par to their existing counterparts. These findings validated the importance of utilizing both the AD and IPD studies whenever they are available, and demonstrated the significance of proper technique for combining these studies in order to obtain better overall estimates.

scholarly journals Which children and young people are at higher risk of severe disease and death after SARS-CoV-2 infection: a systematic review and individual patient meta-analysis

2021 ◽  
Author(s):  
Rachel Harwood ◽  
Helen Yan ◽  
Nish Talawila Da Camara ◽  
Clare Smith ◽  
Joseph Ward ◽  
...  
Keyword(s):  
Critical Care ◽  
Young People ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Severe Disease ◽  
Patient Data ◽  
Comorbid Conditions ◽  
Odds Ratios ◽  
Absolute Increase ◽  
Children And Young People

Background We aimed to use individual patient data to describe pre-existing factors associated with severe disease, primarily admission to critical care, and death secondary to SARS-CoV-2 infection in children and young people (CYP) in hospital. Methods We searched Pubmed, European PMC, Medline and Embase for case series and cohort studies that included all CYP admitted to hospital with ≥30 CYP with SARS-CoV-2 or ≥5 CYP with PIMS-TS or MIS-C. Eligible studies contained 1) details of age, sex, ethnicity or co-morbidities, and 2) an outcome which included admission to critical care, mechanical invasive ventilation, cardiovascular support, or death. Studies reporting outcomes in more restricted grouping of co-morbidities were eligible for narrative review. Authors of eligible studies were approached for individual patient data (IPD). We used random effects meta-analyses for aggregate study-level data and multilevel mixed effect models for IPD data to examine risk factors (age, sex, comorbidities) associated with admission to critical care and death. Data shown are odds ratios and 95% confidence intervals (CI). Findings 81 studies were included, 57 in the meta-analysis (of which 22 provided IPD) and 26 in the narrative synthesis. Most studies had an element of bias in their design or reporting. Sex was not associated with critical care or death. Compared with CYP aged 1-4 years, infants had increased odds of admission to critical care (OR 1.63 (95% CI 1.40-1.90)) and death (OR 2.08 (1.57-2.86)). Odds of death were increased amongst CYP over 10 years (10-14 years OR 2.15 (1.54-2.98); >14 years OR 2.15 (1.61-2.88)). Number of comorbid conditions was associated with increased odds of admission to critical care and death for COVID-19 in a dose-related fashion. For critical care admission odds ratios were: 1 comorbidity 1.49 (1.45-1.53); 2 comorbidities 2.58 (2.41-2.75); ≥3 comorbidities 2.97 (2.04-4.32), and for death: 1 comorbidity 2.15 (1.98-2.34); 2 comorbidities 4.63 (4.54-4.74); ≥3 co-morbidities 4.98 (3.78-6.65). Odds of admission to critical care were increased for all co-morbidities apart from asthma (0.92 (0.91-0.94)) and malignancy (0.85 (0.17-4.21)) with an increased odds of death in all co-morbidities considered apart from asthma. Neurological and cardiac comorbidities were associated with the greatest increase in odds of severe disease or death. Obesity increased the odds of severe disease and death independently of other comorbidities. Interpretation Hospitalised CYP at greatest vulnerability of severe disease or death from SARS-CoV-2 infection are infants, teenagers, those with cardiac or neurological conditions, or 2 or more comorbid conditions, and those who are obese. These groups should be considered higher priority for vaccination and for protective shielding when appropriate. Whilst odds ratios were high, the absolute increase in risk for most comorbidities was small compared to children without underlying conditions.

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