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Review
. 2020 May:223:48-58.
doi: 10.1016/j.ahj.2020.02.011. Epub 2020 Feb 21.

Future research prioritization in cardiac resynchronization therapy

Marat Fudim  1 , Frederik Dalgaard  2 , Sana M Al-Khatib  3 , Daniel J Friedman  1 , Kathryn Lallinger  4 , William T Abraham  5 , John G F Cleland  6 , Anne B Curtis  7 , Michael R Gold  8 , Valentina Kutyifa  9 , Cecilia Linde  10 , Daniel E Schaber  11 , Anthony Tang  12 , Fatima Ali-Ahmed  13 , Sarah A Goldstein  13 , Brystana Kaufman  14 , Robyn Fortman  4 , J Kelly Davis  14 , Lurdes Y T Inoue  15 , Gillian D Sanders  16
Affiliations
Review

Future research prioritization in cardiac resynchronization therapy

Marat Fudim et al. Am Heart J. 2020 May.

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.

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Figures

Figure 1.
Figure 1.. Overview of Prioritization Process
Abbreviations: CRT=cardiac resynchronization therapy; ESG=Evidence Synthesis Group
See this image and copyright information in PMC

References

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