Effect of warfarin on survival in scleroderma-associated pulmonary arterial hypertension (SSc-PAH) and idiopathic PAH. Belief elicitation for Bayesian priors.
Effect of warfarin on survival in scleroderma-associated pulmonary arterial hypertension (SSc-PAH) and idiopathic PAH. Belief elicitation for Bayesian priors.
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DOI：
10.3899/jrheum.100632
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发表时间：
2011-03-01
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影响因子：
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通讯作者：
Feldman, Brian M
中科院分区：
文献类型：
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作者：
Johnson, Sindhu R;Granton, John T;Feldman, Brian M
目的：华法林在硬皮病 (SSc) 相关肺动脉高压 (PAH) 和特发性 PAH (IPAH) 中的使用存在争议。试验的先决条件是证明社区的不确定性。我们评估了专家对华法林对 SSc-PAH 和 IPAH 3 年生存影响的看法，以及影响华法林使用的因素。 方法：参加 2008 年美国风湿病学会或美国胸科学会会议的 PAH 专家通过在一条线上的“箱”中应用粘合点（每个代表 5% 的概率权重）来表达不使用和使用华法林的 3 年生存概率及其不确定性程度，创建先验概率分布或之前。参与者使用数字评分量表对影响华法林使用的因素进行评分。 结果：45 名专家（44% 的肺科医生、38% 的风湿科医生、16% 的心脏病专家、2% 的内科医生）接受了信念启发访谈。对于 SSc-PAH，不使用和使用华法林的 3 年生存率平均概率分别为 54% 和 56%。悲观的专家认为，华法林会使生存率下降 7%。乐观的专家认为，华法林可使生存率提高 13%。在 IPAH 中，不使用和使用华法林的 3 年生存率平均为 68% 和 76%。影响专家使用华法林的因素（平均分 10 分，0 = 完全不重要，10 = 极其重要）包括功能等级 (5.4)、年龄 (5.4)、肺动脉压 (5.2)、外周血管疾病 (3.6)、疾病持续时间 (2.8) 和性别 (1.7)。 结论：贝叶斯先验有效量化并说明了专家关于华法林对患者生存影响的信念。 SSc-PAH 和 IPAH。这项研究表明华法林的作用存在不确定性，并为临床试验提供了理由。
OBJECTIVE: Warfarin use in scleroderma (SSc)-associated pulmonary arterial hypertension (PAH) and idiopathic PAH (IPAH) is controversial. A prerequisite for a trial is the demonstration of community uncertainty. We evaluated experts' beliefs about the effect of warfarin on 3-year survival in SSc-PAH and IPAH, and factors that influence warfarin use.METHODS: PAH experts attending the 2008 American College of Rheumatology or American Thoracic Society meetings expressed the probability of 3-year survival without and with warfarin and their degree of uncertainty by applying adhesive dots, each representing a 5% weight of probability, in "bins" on a line, creating a prior probability distribution or prior. Using a numeric rating scale, participants rated factors that influence their use of warfarin.RESULTS: Forty-five experts (44% pulmonologists, 38% rheumatologists, 16% cardiologists, 2% internists) underwent the belief elicitation interview. In SSc-PAH, the mean probabilities of 3-year survival without and with warfarin were 54% and 56%, respectively. Pessimistic experts believe that warfarin worsens survival by 7%. Optimistic experts believe that warfarin improves survival by 13%. In IPAH, the mean probabilities of 3-year survival without and with warfarin were 68% and 76%. Factors (mean rating out of 10, 0 = not at all important, 10 = extremely important) that influence experts' use of warfarin were functional class (5.4), age (5.4), pulmonary artery pressure (5.2), peripheral vascular disease (3.6), disease duration (2.8), and sex (1.7).CONCLUSION: Bayesian priors effectively quantify and illustrate experts' beliefs about the effect of warfarin on survival in SSc-PAH and IPAH. This study demonstrates the presence of uncertainty about the effect of warfarin, and provides justification for a clinical trial.