Evidence in crisis: a closer look into the quality of published systematic reviews in the cardiology literature

Background Systematic reviews are usually considered as the highest level of evidence and are increasingly used in shaping cardiology policies and guidelines. However, as the rate of publishing systematic reviews increases annually, there are rising concerns regarding their quality and reporting standards. Purpose The current analysis provides an insight into the quality of published systematic reviews in cardiology and provides recommendations for researchers, clinicians, and stakeholders in this regard. Methods Using a comprehensive Medline/PubMed search, we retrieved all systematic reviews, published between 2009 and 2019 in five general cardiology journals with the highest impact factor as per the Clarivate Analytics 2019 Journal Impact Factor List (Circulation, European Heart Journal, Journal of the American College of Cardiology, Circulation Research, and JAMA Cardiology). We assessed the methodological characteristics, eligibility criteria, reporting standards, as well as review quality scores according to the AMSTAR tool. Results Among 352 retrieved reviews, 275 (75.3%) performed direct head-to-head analysis and 164 (46.6%) included only clinical trials. The median numbers of searched databases and included studies were 3 (IQR: 2, 3) and 13 (IQR: 7, 30). The primary outcomes were often hard clinical endpoints as mortality (39.2%) and stroke (11.9%). 64 (18.2%) registered their protocol, 208 (58.4%) used validated tools for risk of bias assessment, 177 (52.3%) assessed for publication bias, and 221 (62.8%) adhered to the PRISMA checklist. Thirty-five reviews detected significant publication bias, which was significantly associated with heterogeneity of the primary outcome. The AMSTAR quality scores were low or critically low in 71% of evaluated reviews. Further, 87 (24.7%) did not report on whether they received funding or not, 33 (9.4%) reported receiving no funding, and 232 adequately reported on their funding sources [70 (19.9%) from governmental/academic sources, 120 (34.1%) from pharmaceutical companies, and 42 (11.9%) from both sources]. analysis showed that reviews with advanced statistical analysis, those that included RCTs, adhered to the PRISMA checklist, or had higher AMSTAR quality scores had significantly higher citation metrics (p<0.05). Conclusion Due to the widespread low quality and poor reporting in cardiovascular systematic reviews, clinicians should be educated on the value of methodological quality in interpreting systematic review findings. In addition, academic societies and guideline writing groups should implement rigorous critical appraisal and peer review policies to improve the synthesis and utilization of systematic reviews in evidence-based cardiovascular medicine. FUNDunding Acknowledgement Type of funding sources: None.

Methodological Rigor and Temporal Trends of Cardiovascular Medicine Meta‐Analyses in Highest‐Impact Journals

Background Well‐conducted meta‐analyses are considered to be at the top of the evidence‐based hierarchy pyramid, with an expansion of these publications within the cardiovascular research arena. There are limited data evaluating the trends and quality of such publications. The objective of this study was to evaluate the methodological rigor and temporal trends of cardiovascular medicine‐related meta‐analyses published in the highest impact journals. Methods and Results Using the Medline database, we retrieved cardiovascular medicine‐related systematic reviews and meta‐analyses published in The New England Journal of Medicine, The Lancet, Journal of the American Medical Association, The British Medical Journal, Annals of Internal Medicine, Circulation, European Heart Journal, and Journal of American College of Cardiology between January 1, 2012 and December 31, 2018. Among 6406 original investigations published during the study period, meta‐analyses represented 422 (6.6%) articles, with an annual decline in the proportion of published meta‐analyses (8.7% in 2012 versus 4.6% in 2018, P trend =0.002). A substantial number of studies failed to incorporate elements of Preferred Reporting Items for Systematic Reviews and Meta‐Analyses or Meta‐Analysis of Observational Studies in Epidemiology guidelines (51.9%) and only a minority of studies (10.4%) were registered in PROSPERO (International Prospective Register of Systematic Reviews). Fewer manuscripts failed to incorporate the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses or Meta‐Analysis of Observational Studies in Epidemiology elements over time (60.2% in 2012 versus 40.0% in 2018, P trend <0.001) whereas the number of meta‐analyses registered at PROSPERO has increased (2.4% in 2013 versus 17.5% in 2018, P trend <0.001). Conclusions The proportion of cardiovascular medicine‐related meta‐analyses published in the highest impact journals has declined over time. Although there is an increasing trend in compliance with quality‐based guidelines, the overall compliance remains low.

POS0507 UNUSUALLY HIGH PREVALENCE OF ATRIAL FIBRILLATION IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:In rheumatoid arthritis, circulating autoantibodies like anticyclic citrullinated peptides and rheumatoid factor may be present for years prior to symptom onset. In RA, there are high levels of circulating tumor necrosis factors, interleukins, matrix metalloproteinases, growth factors, and adhesion molecules that cause tissue damage1,2. This can affect different organs in different ways. It is possible that in the heart, they cause inflammation of cardiac tissue 3,4.Objectives:This study was conducted to determine if patients with RA, an inflammatory arthritis, and osteoarthritis (OA), a degenerative arthritis, differ in the prevalence of cardiac arrhythmias.Methods:This was a retrospective study. We enrolled 300 consecutive patients, 150 with RA and 150 with OA. Patients were assessed for age, race, gender, body mass index (BMI), smoking status, hypertension (HTN), hyperlipidemia (HLD), diabetes mellitus (DM), cardiovascular disease (CVD), coronary artery disease (CAD), cardiac arrhythmias including conduction abnormalities, cerebrovascular accident (CVA), congestive heart failure (CHF), abdominal aortic aneurysm (AAA), pulmonary embolism (PE), deep vein thrombosis (DVT), and peripheral vascular disease (PVD). RA and OA groups were compared with the chi square test and the Mann-Whitney test.Results:The RA and OA groups did not differ on the demographic characteristics of age or race. The presence of DM was similar in the two groups. The RA group had more women than the OA group (12.7% vs. 5.3%, p=0.026). The OA group had a higher mean BMI (33.1 vs 30.0, p<0.001) and higher prevalence of HLD (78.9% vs 64.6%, p=0.007) and HTN (79.3% vs. 66.7%, p=0.013). RA patients had a higher rate of smoking (70.0% vs 56.7%, p=0.017) and longer duration of smoking (34.3 years vs. 28.2 years, p=0.003). The RA group had a higher prevalence of CVD (58.7% vs. 42.7%, p= 0.006). Further data analysis among CVD showed there was no difference between the two groups for the prevalence of CAD, CHF, CVA, AAA, PVD or DVT/PE. RA patients had a higher prevalence of cardiac arrhythmias (31.3% vs. 12.0%, p<0.001). Among all types of cardiac arrhythmias, no significant difference was found between two groups for the prevalence of supraventricular tachycardia, ventricular arrhythmias, or conduction abnormalities. Patients with RA had a significantly higher prevalence of atrial fibrillation (15.3% vs. 6.0%, p = 0.015).Conclusion:Cardiac arrhythmias occur more frequently in RA patients than in OA patients. Among all the arrhythmias, atrial fibrillation has a significantly higher prevalence in RA patients.References:[1]Maradit-Kremers H, et al. Increased unrecognized coronary heart disease and sudden deaths in rheumatoid arthritis: A population-based cohort study. Arthritis Rheum. 2005; 52: 402-411[2]Seferovic PM, et al. Cardiac arrhythmias and conduction disturbances in autoimmune rheumatic diseases. Rheumatology. 2006; 45: 39-42[3]Avina-Zubiets JA, et al. Risk of incident cardiovascular events in patients with rheumatoid arthritis: A met-analysis of observational studies. Ann Rheum Dis 2012; 71: 1524-1529[4]Lazzerini PE, Capechi L, et al. Systemic Inflammation and arrhythmic risk: Lessons from rheumatoid arthritis. European Heart Journal. 2017; 38: 1717-1727Disclosure of Interests:None declared

Gender Differences in Publication Authorship During COVID‐19: A Bibliometric Analysis of High‐Impact Cardiology Journals

Background The purpose of this study was to examine gender differences in authorship of manuscripts in select high‐impact cardiology journals during the early coronavirus disease 2019 (COVID‐19) pandemic. Methods and Results All manuscripts published between March 1, 2019 to June 1, 2019 and March 1, 2020 to June 1, 2020 in 4 high‐impact cardiology journals ( Journal of the American College of Cardiology , Circulation , JAMA Cardiology , and European Heart Journal ) were identified using bibliometric data. Authors' genders were determined by matching first name with predicted gender using a validated multinational database (Genderize.io) and manual adjudication. Proportions of women and men first, co‐first, senior, and co‐senior authors, manuscript types, and whether the manuscript was COVID‐19 related were recorded. In 2019, women were first authors of 176 (22.3%) manuscripts and senior authors of 99 (15.0%) manuscripts. In 2020, women first authored 230 (27.4%) manuscripts and senior authored 138 (19.3%) manuscripts. Proportions of woman first and senior authors were significantly higher in 2020 compared with 2019. Women were more likely to be first authors if the manuscript's senior author was a woman (33.8% for woman first/woman senior versus 23.4% for woman first/man senior; P <0.001). Women were less likely to be first authors of COVID‐19‐related original research manuscripts ( P =0.04). Conclusions Representation of women as key authors of manuscripts published in major cardiovascular journals increased during the early COVID‐19 pandemic compared with similar months in 2019. However, women were significantly less likely to be first authors of COVID‐19‐related original research manuscripts. Future investigation into the gender‐disparate impacts of COVID‐19 on academic careers is critical.