Journal club: STEP-HFpEF and symptom endpoints — setting out what I have, and where I think it stops being reliable.
The question about step-hfpef and symptom endpoints that I actually want answered is the second one below. The first is context and I have kept it short.
Both are stated with units, and I have said what I already checked so that nobody repeats it.
Everything in the opening post holds. The case it does not cover is the one I have.
Sessions on negative or null results are consistently the most instructive and the hardest to get anyone to attend.
Not a strong opinion, just a consistent one.
Worth separating two things that post #3 runs together.
The practical version of step-hfpef and symptom endpoints is three sentences long. The rigorous version is three pages and reaches the same conclusion with the conditions attached.
This follows post #3 rather than contradicting it.
On step-hfpef and symptom endpoints the community has more anecdote than the confidence in this thread implies, and I include my own contribution in that.
On post #7 — agreed on the reasoning, with one qualification.
Step-hfpef and symptom endpoints: I have looked for the primary source twice and failed twice. Either it does not exist or it is somewhere I do not know to look, and I would like to know which.
SURMOUNT-OSA (N Engl J Med 2024): Tirzepatide in obstructive sleep apnoea, using an objective physiological endpoint. Notable because soft endpoints are avoided. Two parallel trials addressed the confounder directly.
One of those cases where knowing the mechanism does not help the decision.
The claim about step-hfpef and symptom endpoints upthread is stronger than its source supports. I have read the source. The source says "associated with" and the post says "causes".
The most common failure mode is spending fifty minutes on the effect size and ten on the population. Reversing that ratio would improve most sessions.
A modest claim, modestly supported.
Coming back to post #10, because the follow-up matters more than the original answer.
Adding what did not work for me on step-hfpef and symptom endpoints, since the failures never get written up and they are half the useful information.
Adding the measurement that post #12 says would settle it.
The reason step-hfpef and symptom endpoints is hard to answer is that the obvious measurement and the relevant quantity are not the same thing, and substituting one for the other is silent.
The figures usually contain the finding and the text usually contains the interpretation. Separating them for the first twenty minutes is a discipline worth keeping.
Filing this under things that are true until someone shows me otherwise.
Reading order that works for these sessions: registry entry, methods, baseline table, primary result, then abstract last. Reading the abstract first anchors everything that follows.
It took me longer than it should have to see that.
I had written a reply contradicting post #14 and deleted it. Here is what survived.
Step-hfpef and symptom endpoints: I would want to see the raw numbers rather than the summary before agreeing. Summaries lose exactly the information that would settle this.
Adding the measurement that post #19 says would settle it.
The most common failure mode is spending fifty minutes on the effect size and ten on the population. Reversing that ratio would improve most sessions.
Not disagreeing with anyone above, just adding the bit I keep having to look up.
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