Future research prioritization in cardiac resynchronization therapy

Fudim, M. et al. (2020) Future research prioritization in cardiac resynchronization therapy. American Heart Journal, 223, pp. 48-58. (doi: 10.1016/j.ahj.2020.02.011) (PMID:32163753)

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Abstract

Background: Although cardiac resynchronization therapy (CRT) is effective for some patients with heart failure and a reduced left ventricular ejection fraction (HFrEF), evidence gaps remain for key clinical and policy areas. The objective of the study was to review the data on the effects of CRT for patients with HFrEF receiving pharmacological therapy alone or pharmacological therapy and an implantable cardioverter-defibrillator (ICD) and then, informed by a diverse group of stakeholders, to identify evidence gaps, prioritize them, and develop a research plan. Methods: Relevant studies were identified using PubMed and EMBASE and ongoing trials using clinicaltrials.gov. Forced-ranking prioritization method was applied by stakeholders to reach a consensus on the most important questions. Twenty-six stakeholders contributed to the expanded list of evidence gaps, including key investigators from existing randomized controlled trials and others representing different perspectives, including patients, the public, device manufacturers, and policymakers. Results: Of the 18 top-tier evidence gaps, 8 were related to specific populations or subgroups of interest. Seven were related to the comparative effectiveness and safety of CRT interventions or comparators, and 3 were related to the association of CRT treatment with specific outcomes. The association of comorbidities with CRT effectiveness ranked highest, followed by questions about the effectiveness of CRT among patients with atrial fibrillation and the relationship between gender, QRS morphology and duration, and outcomes for patients either with CRT plus ICD or with ICD. Conclusions: Evidence gaps presented in this article highlight numerous, important clinical and policy questions for which there is inconclusive evidence on the role of CRT and provide a framework for future collaborative research.

Item Type:Articles
Additional Information:Primary funding was provided by the National Heart, Lung, and Blood Institute (1R01HL131754).
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Cleland, Professor John
Authors: Fudim, M., Dalgaard, F., Al-Khatib, S. M., J. Friedman, D., Lallinger, K., Abraham, W. T., Cleland, J. G.F., Curtis, A. B., Gold, M. R., Kutyifa, V., Linde, C., Schaber, D. E., Tang, A., Ali-Ahmed, F., Goldstein, S. A., Kaufman, B., Fortman, R., Davis, J. K., Inoue, L. Y.T., and Sanders, G. D.
Subjects:R Medicine > R Medicine (General)
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:American Heart Journal
Publisher:Elsevier
ISSN:0002-8703
ISSN (Online):1097-6744
Published Online:21 February 2020
Copyright Holders:Copyright © 2020 Elsevier Inc.
First Published:First published in American Heart Journal 223: 48-58
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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