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. 2015 Dec;30(12):1812-20.
doi: 10.1007/s11606-015-3411-6.

Future Research Prioritization: Implantable Cardioverter-Defibrillator Therapy in Older Patients

Sana M Al-Khatib  1 , Jennifer M Gierisch  1   2   3 , Matthew J Crowley  1   2   3 , Remy R Coeytaux  2   4 , Evan R Myers  2   5 , Amy Kendrick  2 , Gillian D Sanders  6   7
Affiliations

Future Research Prioritization: Implantable Cardioverter-Defibrillator Therapy in Older Patients

Sana M Al-Khatib et al. J Gen Intern Med. 2015 Dec.

Abstract

Background: Although the implantable cardioverter-defibrillator (ICD) is highly effective therapy for preventing sudden cardiac death, there is considerable uncertainty about its benefits and harms in older patients, especially in the presence of factors, other than old age, that increase the risk of death.

Objective: To develop a prioritized research agenda for the Patient-Centered Outcomes Research Institute as informed by a diverse group of stakeholders on the use and outcomes of the ICD in older patients.

Design: The existing literature was reviewed to identify evidence gaps, which were then refined by engaged stakeholders. Using a forced-ranking prioritization method, the stakeholders ranked evidence gaps by importance. For the highest-ranked evidence gaps, relevant recent studies were identified using PubMed, and relevant ongoing trials were identified using ClinicalTrials.gov.

Participants: Eighteen stakeholders, including clinical experts and researchers in the prevention of sudden cardiac death and ICD therapy, representatives from federal and non-governmental funding agencies, representatives from relevant professional societies, health care decision-makers and policymakers, and representatives from related consumer and patient advocacy groups

Key results: The top 12 evidence gaps prioritized by stakeholders were related to the safety and effectiveness of ICDs in older patient subgroups not well represented in clinical trials, predictors of SCD, the impact of the ICD on quality of life, the use of shared decision-making, disparities in ICD use, risk stratification strategies, patient preferences, and distribution of modes of death in older patients.

Conclusions: In this paper, we identify evidence gaps of high priority for current and future investigations of ICD therapy. Addressing these gaps will likely resolve many of the uncertainties surrounding the use and outcomes of the ICD in older patients seen in clinical practice.

Keywords: cardiovascular disease; decision making; stakeholder engagement.

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Figures

Figure 1
Figure 1
Overview of prioritization process. Adapted from Ip S, Raman G, Concannon T, et al. Intravascular Diagnostic Procedures and Imaging Techniques Versus Angiography Alone in Coronary Artery Stenting: Future Research Needs. Future Research Needs Paper No. 25. (Prepared by Tufts Evidence-based Practice Center under Contract No. 290-2007-10055-I.) AHRQ Publication No. 13-EHC016-EF. Rockville, MD: Agency for Healthcare Research and Quality. February 2013. Available at: www.effectivehealthcare.ahrq.gov/reports/final.cfm. Accessed March 3, 2015. Abbreviations: ESG Evidence Synthesis Group, PCORI Patient-Centered Outcomes Research Institute
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