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- W2148363263 abstract "To the Editor: We read with interest the report of Ling et al1 that examined long-term outcome in a cohort of patients in whom pure mitral regurgitation due to flail leaflet was first diagnosed by echocardiography between 1980 and 1989.In the introduction, the authors correctly state that it is uncertain whether early surgery or conservative management should be the preferred approach in these patients, irrespective of symptoms. Accordingly, they analyzed their cohort on an “intention-to-treat” basis, comparing follow-up events among patients who underwent surgery within 1 month after the diagnosis (the early-surgery group) with those who did not (the conservative-treatment group). Because this was not a randomized trial, the validity of the study is threatened by incomparability of prognosis of both treatment groups at baseline (ie, confounding).Age is always an extremely important potential confounder. When the baseline characteristics of the patients at the time of diagnosis are compared (Table 1 in the article), there is an important difference in mean age between the early-surgery group and the conservative-treatment group (61.1 versus 66.5 years), which is called “slight” by the authors. The estimated probability of 10-year survival for 61- and 67-year-old men (at approximately 1990 in The Netherlands) was 77.7% and 63.7% respectively, a difference of 14%. The same difference (14% in 10-year survival) was found between early surgery and conservative treatment in the present study. The horizontal distance between the 2 …" @default.
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- W2148363263 date "1998-09-29" @default.
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- W2148363263 title "Effect of age adjustment in predicting outcome." @default.
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