Duke researchers identify CV subspecialties that could benefit from comparative effectiveness reviews

April 9, 2013 – Zubin Eapen, MD, and others identified cardiology subspecialties that might have gaps in evidence-based guidelines and need further study.

Despite the number of cardiovascular trials that are conducted annually, only 11 percent of guideline recommendations from the American College of Cardiology and the American Heart Association in 2009 had a Level of Evidence A, the highest rating. Most guidelines are based on expert opinion or case studies, not evidence from randomized clinical trials. As a result, there is significant variations and disparities in cardiovascular care, and reducing the variation in care can help lower mortality rates and reduce healthcare costs. Comparative effectiveness reviews can identify areas with high variation in care and poor patient outcomes. Duke researchers recently prioritized specific areas in cardiovascular research where comparative reviews are most needed.

The results were published in the March issue of Circulation: Cardiovascular Quality & Outcomes. The DCRI’s Zupin Eapen, MD, was the lead author and Gillian Sanders, PhD, was the senior author.

Comparative effectiveness reviews provide a critical way to assess existing research and identify the areas of greatest clinical uncertainty. Where can new evidence or additional evidence-based guidelines help reduce mortality, or streamline care and reduce costs? The Effective Health Care (EHC) Program of the Agency for Healthcare Research helps to select topics for comparative effectiveness reviews. The Duke Evidence-based Practice Center worked with a range of cardiovascular experts to prioritize a list of cardiovascular topics for the EHC that could benefit the most from these types of reviews.

Topics for consideration included both established treatments, such as using clopidogrel with drug-eluting stents, and newer treatments, such as aortic valve replacements for high-risk patients. Those that were ranked in the top 10 by at least two stakeholders were added to the final selection of topics to consider. When making the final selection, the researchers and stakeholders considered the number of completed or ongoing trials for each topic, as well as the number of guidelines and systematic reviews that exist for each.

The 11 subcategories of cardiovascular research found to have gaps in evidence-based guidelines or those requiring additional evidence synthesis included four from chronic coronary artery disease, one from arrhythmias, four from heart failure, and two from cerebrovascular disease. These 11 topics were recommended for future systematic reviews. Researchers hope that using a systematic approach to prioritizing future comparative effectiveness reviews will ultimately reduce patient mortality, improve patient outcomes and the quality of care, and reduce healthcare costs.

Other DCRI authors include Amanda McBroom, PhD; Rebecca Gray, DPhil; and Adrian Hernandez, MD.