“The best interest of the patient is the only interest to be considered.”— William J. Mayo, MD1
- Mayo W.J.Quotations from the Doctors Mayo. Mayo Clinic website.
Relative vs Absolute Risk Framing
Aggregate vs Individualized Risk Framing
|Clinical statement||Outcome||Event rate (%)||RRR (%)||ARR (%)||NNT||Likelihood of no benefit (%)||Individualized risk/benefit score|
|ASA + clopidogrel is superior to ASA alone in patients with acute coronary syndrome and no ST-segment elevation||MACE|
|9.3 vs 11.4||20||2.1||47||97.9||Not available|
|Apixaban reduces the risk of hemorrhagic strokes by 50% compared with warfarin||Hemorrhagic stroke||0.24 vs 0.47||49||0.23||238||99.8||Not available|
|Adding canagliflozin to standard of care in diabetic patients with renal insufficiency improves outcomes||MACE|
|9.9 vs 12.2||20||2.3||40||97.7||Not available|
Dual Antiplatelet Therapy in Patients With Acute Coronary Syndrome Without ST-Segment Elevation
Apixaban vs Warfarin for Stroke Prevention in Patients With Nonvalvular Atrial Fibrillation
- Mui K.
Canagliflozin in Diabetic Patients With Renal Insufficiency
Supplemental Online Material
- Quotations from the Doctors Mayo. Mayo Clinic website.Accessed September 8, 2019)
- Mandatory shared decision making by the Centers for Medicare & Medicaid Services for cardiovascular procedures and other tests.JAMA. 2018; 320: 641-642
- Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation.N Engl J Med. 2001; 345: 494-502
- Apixaban versus warfarin in patients with atrial fibrillation.N Engl J Med. 2011; 365: 981-992
- Warfarin alternatives: are Eliquis and Xarelto worth the cost? GoodRx website.Published March 7, 2019. Accessed September 8, 2019)
- Canagliflozin and cardiovascular and renal outcomes in type 2 diabetes and chronic kidney disease in primary and secondary cardiovascular prevention groups: results from the randomized CREDENCE trial.Circulation. 2019; 140: 739-750
Potential Competing Interests: The authors report no competing interests.