scholarly journals Letter by Nielsen and Søgaard Regarding Article, “Rivaroxaban Versus Apixaban for Stroke Prevention in Atrial Fibrillation: An Instrumental Variable Analysis of a Nationwide Cohort”

2020 ◽  
Vol 13 (8) ◽  
Author(s):  
Peter Brønnum Nielsen ◽  
Mette Søgaard
Keyword(s):  
Atrial Fibrillation ◽  
Stroke Prevention ◽  
Instrumental Variable ◽  
Instrumental Variable Analysis ◽  
Variable Analysis

scholarly journals Prophylactic Magnesium Supplementation and New-Onset Atrial Fibrillation in a General Critical Care Population: A Prescribing Preference Instrumental Variable Analysis

2021 ◽  
Author(s):  
Matthew G Wilson ◽  
Aasiyah Rashan ◽  
Roman Klapaukh ◽  
Folkert W Asselbergs ◽  
Steve K Harris
Keyword(s):  
Atrial Fibrillation ◽  
Critical Care ◽  
Instrumental Variable ◽  
Serum Magnesium ◽  
Multilevel Modelling ◽  
Magnesium Supplementation ◽  
Instrumental Variable Analysis ◽  
Onset Atrial Fibrillation ◽  
New Onset ◽  
Variable Analysis

Aims Atrial fibrillation is frequently encountered in critical illness and causes adverse effects including haemodynamic decompensation, stroke and longer hospital stay. It is common to supplement serum magnesium for the purpose of preventing new-onset atrial fibrillation. However, no randomised studies support this practice in the non-cardiac surgery critical care population, and its effectiveness is unclear. We sought to investigate the effectiveness of magnesium supplementation in preventing new-onset atrial fibrillation in a mixed critical care population. Methods We conducted a single centre retrospective observational study of adult critical care patients. We employed a natural experiment design, using the supplementation preference of the bedside critical care nurse as an instrumental variable. Using the electronic patient record, magnesium supplementation opportunities were defined and linked to the bedside nurse. Nurse preference for administering magnesium was obtained using multilevel modelling. The results were used to define pro and anti supplementation groups, which were inputted into an instrumental variable regression to obtain an estimate of the effect of magnesium supplementation. Results 9,114 magnesium supplementation opportunities were analysed, representing 2,137 critical care admissions for 1,914 patients. There was significant variation in magnesium supplementation practices attributable to the individual nurse, after accounting for covariates. The instrumental variable analysis showed magnesium supplementation was associated with a 3% decreased chance of experiencing new-onset atrial fibrillation (95% CI -0.06 to -0.04, p = 0.03). Conclusions This study supports the strategy of routine magnesium supplementation, but further work is required to identify optimal serum magnesium targets for prophylaxis of atrial fibrillation.

Abstract 2323: Statin Use and Discharge Disposition After Ischemic Stroke Hospitalization

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Alexander Flint ◽  
Hooman Kamel ◽  
Babak Navi ◽  
Vivek Rao ◽  
Bonnie Faigeles ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Instrumental Variable ◽  
Multivariable Analysis ◽  
Treatment Patterns ◽  
High Dose ◽  
Instrumental Variable Analysis ◽  
Discharge Disposition ◽  
Usual Dose ◽  
Statin Use ◽  
Variable Analysis

Objective: To determine whether statin use is associated with improved discharge disposition after ischemic stroke. Methods: We analyzed 12,689 patients with ischemic stroke over a 7 year period at 17 hospitals in Kaiser Permanente Northern California. We used multivariable generalized ordinal logistic regression and instrumental variable analysis of treatment patterns by hospital to control for the possibility of confounding. Results: Statin users before and during stroke hospitalization were more likely to be discharged home (54.9% for statin users, 46.3% for statin non-users) and less likely to die in hospital (5.3% for statin users, 10.3% for statin non-users). Patients who underwent statin withdrawal in-hospital were less likely to be discharged home (39.1% for statin withdrawal, 54.9% for statin continuation) and more likely to die in hospital (22.3% for statin withdrawal, 5.3% for statin continuation). Users of higher statin doses (>60 mg / day) were even more likely to be discharged home (62.5% for high dose statin, 56.5% for usual dose statin, and 47.4% for no statin) and less likely to die in hospital in-hospital (3.5% for high dose statin, 5.6% for usual dose statin, and 10.6% for no statin). These results were confirmed by multivariable analysis. The association of statin use and improved outcomes was also confirmed by instrumental variable analysis of treatment patterns by hospital, and thus this association cannot be explained by confounding at the individual patient level. Conclusions: Statin use is associated with improved discharge disposition after ischemic stroke, particularly at higher doses.

Methods matter: dealing with low compliance in sports injury trials analyses using instrumental variable analysis

2020 ◽  
pp. bjsports-2020-102155
Author(s):  
Pascal Edouard ◽  
Kathrin Steffen ◽  
Laurent Navarro ◽  
Mohammad Ali Mansournia ◽  
Rasmus Oestergaard Nielsen
Keyword(s):  
Instrumental Variable ◽  
Sports Injury ◽  
Instrumental Variable Analysis ◽  
Variable Analysis
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