You are here

Article Text

Article menu
Download PDFPDF
Editorial
Meta-analysis: mistake or milestone in medicine?
  1. Farid Foroutan1,2,
  2. Gordon Guyatt2,
  3. Ana Carolina Alba1,
  4. Heather Ross1
  1. 1 Ted Rogers Centre of Excellence in Heart Function, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
  2. 2 Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
  1. Correspondence to Farid Foroutan, Ted Rogers Centre of Excellence in Heart Function, Peter Munk Cardiac Centre, University Health Network, Toronto, ON M5G 2C4, Canada; farid.foroutan{at}uhn.ca

https://doi.org/10.1136/heartjnl-2018-313042

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Since 1981, Evidence-Based Medicine (EBM) has evolved into a framework for partnering with patients to resolve or cope with health problems, taking full advantage of available research evidence.1 The modern practice of EBM relies on three fundamental principles1: (1) optimal clinical decision making requires a systematic review of the best available evidence; meta-analysis sometimes, though not always, strengthens associations, (2) using sophisticated framework for judging the quality or trustworthiness of evidence and (3) consideration of trade-offs between benefits, risks, burden and costs, on the basis of patients’ values and preferences.

    Despite EBM’s wide acceptance over the past 30 years, scepticism remains. Specifically, sceptics of EBM’s first principle believe that our knowledge of cardiovascular medicine would be no different with or without the utilisation of systematic reviews and meta-analyses for ascertainment of evidence.2 Such beliefs are not unsupported on social media platforms such as Twitter, by means of tweets and retweets, over 270 000 knowledge users have expressed scepticism against systematic reviews and meta-analyses.3 In this editorial, we present a meta-analyst’s perspective, providing evidence to support EBM’s first principle regarding the use of systematic reviews and meta-analyses to better inform the cardiology audience.

    Advantages of systematic reviews and meta-analyses

    For any well-formulated research question, systematic reviews and meta-analyses can identify all the available relevant evidence (systematic search), critically appraise the risk of bias of the identified evidence, combine the results to increase statistical power (meta-analysis when appropriate), identify sources of variation across studies (subgroup analyses) and rate the overall quality of the evidence (certainty in the results).

    Increased statistical power and precise estimates

    History demonstrates the advantage of systematic reviews and meta-analyses over narrative reviews. In 1992, Antman et al 4 compared expert recommendations for management of patients with myocardial infarction (MI) with the best evidence available at the time. The authors conducted a retrospective cumulative meta-analysis (performing a …

    View Full Text

    Footnotes

    • Contributors All authors contributed to the drafting and revising of the submitted manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Provenance and peer review Commissioned; internally peer reviewed.