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An approach that is more productive and more realistic is to place the likelihood that a subgroup effect is real on a continuum from “highly plausible” to “extremely unlikely”, possibly by using a visual analogue scale.
For example, consider the effect of statin therapy on major coronary events (that is, non-fatal myocardial infarction and coronary heart disease death) in patients with varying coronary risks.
A 45 year old non-smoking woman without a family history of heart disease and without diabetes presents with a raised serum cholesterol (5.2 mmol/L and a blood pressure of 130/85 mm Hg.
Her risk of major coronary events in the next decade is 5%.
Compare this woman to a 65 year old smoking male with a family history of heart diseases and diabetes, presenting with a raised serum cholesterol ( 6.2 mmol/L), and blood pressure of 160/90 mm Hg. A meta-analysis showed that statin therapy could reduce the relative risk of major coronary events by 29.2%.25 This relative effect was consistent across subgroups, including the determinants of coronary risk discussed in the previous paragraph.
Debates about subgroup effects may be framed in terms of absolute acceptance or rejection.
For instance, in an intense academic debate,5 6 7 8 9 10 11 one camp maintained that effects of propranolol on death differed in two groups of study centres, whereas the other remained highly sceptical.We also offer an Accelerated Career Entry Program and an RN/BSN Completion Program.As a part of the Undergraduate Nursing Department, you will join a community of clinicians, researchers, faculty, and students in your journey toward nursing practice.Subgroup analyses are common and often associated with claims of difference of treatment effects between subgroups—termed “subgroup effect”, “effect modification”, or “interaction between a subgroup variable and treatment”.1 2 3 A difference in effect between subgroups, if true, is likely to have important implications for clinical practice and policy making.Many subgroup claims are, however, subsequently shown to be false.4 Thus, investigators, clinicians, and policy makers face the challenge of whether or not to believe apparent differences in effect.They advocated a priori specification of subgroup hypotheses, completion of a small number of subgroup analyses, and use of an interaction test for analysing subgroup effects.