{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T21:40:43Z","timestamp":1792100443174,"version":"4.4.0"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"15","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2014,10,7]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>Many clinical trials use composite end points to reduce sample size, but the relative importance of each individual end point within the composite may differ between patients and researchers.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>\n              We asked 785 cardiovascular patients and 164 clinical trial authors to assign 25 \u201cspending weights\u201d across 5 common adverse events comprising composite end points in cardiovascular trials: death, myocardial infarction, stroke, coronary revascularization, and hospitalization for angina. We then calculated end point ratios for each participant\u2019s ratings of each nonfatal end point relative to death. Whereas patients assigned an average weight of 5 to death, equal or greater weight was assigned to myocardial infarction (mean ratio, 1.12) and stroke (ratio, 1.08). In contrast, clinical trialists were much more concerned about death (average weight, 8) than myocardial infarction (ratio, 0.63) or stroke (ratio, 0.53). Both patients and trialists considered revascularization (ratio, 0.48 and 0.20, respectively) and hospitalization (ratio, 0.28 and 0.13, respectively) as substantially less severe than death. Differences between patient and trialist end point weights persisted after adjustment for demographic and clinical characteristics (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001 for all comparisons).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>Patients and clinical trialists did not weigh individual components of a composite end point equally. Whereas trialists are most concerned about avoiding death, patients place equal or greater importance on reducing myocardial infarction or stroke. Both groups considered revascularization and hospitalization as substantially less severe. These findings suggest that equal weights in a composite clinical end point do not accurately reflect the preferences of either patients or trialists.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circulationaha.113.006588","type":"journal-article","created":{"date-parts":[[2014,9,9]],"date-time":"2014-09-09T04:37:16Z","timestamp":1410237436000},"page":"1254-1261","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":132,"title":["Rethinking Composite End Points in Clinical Trials"],"prefix":"10.1161","volume":"130","author":[{"given":"Joshua M.","family":"Stolker","sequence":"first","affiliation":[{"name":"From Saint Louis University, St. Louis, MO (J.M.S., K.K.J.); University of Missouri\u2013Kansas City, Kansas City (J.A.S., D.J.C., E.B., B.B.L., P.S.C.); and Saint Luke\u2019s Mid America Heart and Vascular Institute; Kansas City, MO (D.J.C., P.G.J., P.S.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John A.","family":"Spertus","sequence":"additional","affiliation":[{"name":"From Saint Louis University, St. Louis, MO (J.M.S., K.K.J.); University of Missouri\u2013Kansas City, Kansas City (J.A.S., D.J.C., E.B., B.B.L., P.S.C.); and Saint Luke\u2019s Mid America Heart and Vascular Institute; Kansas City, MO (D.J.C., P.G.J., P.S.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Cohen","sequence":"additional","affiliation":[{"name":"From Saint Louis University, St. Louis, MO (J.M.S., K.K.J.); University of Missouri\u2013Kansas City, Kansas City (J.A.S., D.J.C., E.B., B.B.L., P.S.C.); and Saint Luke\u2019s Mid America Heart and Vascular Institute; Kansas City, MO (D.J.C., P.G.J., P.S.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip G.","family":"Jones","sequence":"additional","affiliation":[{"name":"From Saint Louis University, St. Louis, MO (J.M.S., K.K.J.); University of Missouri\u2013Kansas City, Kansas City (J.A.S., D.J.C., E.B., B.B.L., P.S.C.); and Saint Luke\u2019s Mid America Heart and Vascular Institute; Kansas City, MO (D.J.C., P.G.J., P.S.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaushik K.","family":"Jain","sequence":"additional","affiliation":[{"name":"From Saint Louis University, St. Louis, MO (J.M.S., K.K.J.); University of Missouri\u2013Kansas City, Kansas City (J.A.S., D.J.C., E.B., B.B.L., P.S.C.); and Saint Luke\u2019s Mid America Heart and Vascular Institute; Kansas City, MO (D.J.C., P.G.J., P.S.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Bamberger","sequence":"additional","affiliation":[{"name":"From Saint Louis University, St. Louis, MO (J.M.S., K.K.J.); University of Missouri\u2013Kansas City, Kansas City (J.A.S., D.J.C., E.B., B.B.L., P.S.C.); and Saint Luke\u2019s Mid America Heart and Vascular Institute; Kansas City, MO (D.J.C., P.G.J., P.S.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brady B.","family":"Lonergan","sequence":"additional","affiliation":[{"name":"From Saint Louis University, St. Louis, MO (J.M.S., K.K.J.); University of Missouri\u2013Kansas City, Kansas City (J.A.S., D.J.C., E.B., B.B.L., P.S.C.); and Saint Luke\u2019s Mid America Heart and Vascular Institute; Kansas City, MO (D.J.C., P.G.J., P.S.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul S.","family":"Chan","sequence":"additional","affiliation":[{"name":"From Saint Louis University, St. Louis, MO (J.M.S., K.K.J.); University of Missouri\u2013Kansas City, Kansas City (J.A.S., D.J.C., E.B., B.B.L., P.S.C.); and Saint Luke\u2019s Mid America Heart and Vascular Institute; Kansas City, MO (D.J.C., P.G.J., P.S.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.289.19.2554"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(97)00497-9"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.82.5.1847"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.06.065"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2007.10.034"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.289.19.2575"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.2017"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.108.766907"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.scitotenv.2009.08.008"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.285.13.1711"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200104123441502"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2008.09.010"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0804626"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.86.2.683"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2008.12.079"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2010.12.026"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0258(19970330)16:6<681::AID-SIM487>3.0.CO;2-H"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-155-9-201111010-00004"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2008.01.009"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39136.682083.AE"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.4780110402"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/0197-2456(92)90020-Z"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa042934"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1161\/strokeaha.110.600106"},{"key":"e_1_3_3_26_2","volume-title":"Global burden of disease 2004 update: disability weights for diseases and conditions","author":"World Health Organization","year":"2004","unstructured":"World Health Organization. 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Accessed February 24, 2013."},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.320.7246.1380"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.323.7323.1218"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X05280558"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2012.05.027"}],"container-title":["Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCULATIONAHA.113.006588","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T06:46:22Z","timestamp":1715582782000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006588"}},"subtitle":["Insights From Patients and Trialists"],"short-title":[],"issued":{"date-parts":[[2014,10,7]]},"references-count":29,"journal-issue":{"issue":"15","published-print":{"date-parts":[[2014,10,7]]}},"alternative-id":["10.1161\/CIRCULATIONAHA.113.006588"],"URL":"https:\/\/doi.org\/10.1161\/circulationaha.113.006588","relation":{},"ISSN":["0009-7322","1524-4539"],"issn-type":[{"value":"0009-7322","type":"print"},{"value":"1524-4539","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,10,7]]},"assertion":[{"value":"2013-09-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2014-08-06","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2014-09-08","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}