We read with great delight the letter concerning our recently published systematic review and meta-analysis on frailty and clinical outcomes in heart failure.
1First, we thank the authors for reading our manuscript in detail and for expressing their critical comments. Second, these authors should be commended for going to great lengths seeking responses from the authors of the original studies. Third, their use of 6 colors (excluding black) in their Table 1 facilitated the readership for understanding the different aspects of their text. In their letter, they provided the JAMDA readership a succinct summary of the pathophysiology, natural history, progression, and outcomes of heart failure, to which we take tremendous pleasure in referring our medical students for their learning. Indeed, in our daily clinical practice, we notice that heart failure patients exhibit chronic stable phases, on which acute episodes of decompensation are superimposed. Further, we are delighted to learn that there are marked differences in outcomes between inpatients and outpatients for heart failure patients, which is an unsurprising observation. However, although the authors have described “periods of stabilization following appropriate treatment,” we have encountered patients in whom stabilization was not achieved following appropriate and indeed optimal treatment, and in whom unfortunate permanent cessation of life inevitably followed.
- Zhang Y.
- Yuan M.
- Gong M.
- et al.
Frailty and clinical outcomes in heart failure: A systematic review and meta-analysis.
J Am Med Dir Assoc. 2018; 19: 1003-1008
Table 1Comparisons of the Hazard Ratios (HRs) in the Original and the Revised Analysis
|Outcome||HRs in the Original Analysis||HRs in the Revised Analysis|
|All-cause mortality (exclusion of abstracts/conference proceedings)||1.59 (1.39-1.82)||1.57 (1.36-1.81)|
|All-cause mortality||1.59 (1.39-1.82)||1.57 (1.37-1.81)|
|Hospital admission||1.31 (1.21-1.42)||1.32 (1.22-1.43)|
|All-cause mortality after left ventricular device implantation||1.62 (1.36-1.93)||1.61 (1.34-1.94)|
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Published online: November 08, 2018
Y. Zhang and M. Yuan are co–first authors and equal contributors.
The authors declare no conflicts of interest.
© 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
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- Letter by Fung et al Regarding Article, “Frailty and Clinical Outcomes in Heart Failure: A Systematic Review and Meta-analysis”Journal of the American Medical Directors AssociationVol. 19Issue 12
- PreviewThe following two letters consist of a critique and author's reply related to an article in this month's journal, which was published online early enough to obtain both the letter and reply in time to publish all three simultaneously. The letter by Fung et al raises legitimate questions about the conduct and interpretation of data in a systematic review and meta-analysis, which the response by Zhang et al addresses point-by-point. Taken together, these correspondences illustrate many of the challenges inherent in conducting a comprehensive and valid systematic review and meta-analysis.