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The unmet need for addressing cardiac issues in intensive care research
Sean van Diepen1, Christopher B Granger, Michael Jacka
11Divisions of Critical Care and Cardiology, University of Alberta, Edmonton, Alberta, Canada. 2Duke Clinical Research Institute, Duke University Medical Center, Durham, NC. 3Division of Critical Care, University of Alberta, Edmonton, Alberta, Canada. 4Milton S. Hershey Medical Center, Penn State University, Hershey, PA. 5Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA. 6Divisions of Cardiology and Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Insights
Critically ill cardiac patients are frequently admitted to intensive care units (ICUs), yet cardiac research in these ICUs is notably scarce. This study reveals a significant gap in cardiac-specific studies and funding compared to other critical care research areas.
Area of Science:
- Critical Care Medicine
- Cardiovascular Research
- Clinical Trials Analysis
Background:
- Cardiovascular disorders are common among intensive care unit (ICU) patients.
- There is limited understanding of the extent of cardiac research within adult ICUs.
Purpose of the Study:
- To assess the proportion of cardiac-specific research among adult ICU studies.
- To identify the focus of current clinical trials and research grants related to ICU patients.
Main Methods:
- Retrospective analysis of clinical trials from ClinicalTrials.gov (1999-2012).
- Review of funding grants from the Canadian Institutes for Health Research (1999-2012).
- Identification of studies involving adult ICU patients and cardiac interventions or outcomes.
Main Results:
- Out of 192 studies in ClinicalTrials.gov, only 4.6% were cardiac-specific.
- Of 105 Canadian Institutes for Health Research grants, only 1.9% focused on cardiac research.
- Respiratory, infectious, and neurologic research were more prevalent than cardiac research in ICUs.
Conclusions:
- A significant disparity exists between the prevalence of cardiac disease in ICUs and the amount of cardiac-specific research conducted.
- This underrepresentation highlights a need for increased research focus on critically ill cardiac patients to improve outcomes.
Objective:
Patients with primary cardiovascular disorders and comorbidities are commonly admitted to ICUs; however, little is known about the current state of cardiac research being conducted in these adult ICU patients.
Design:
Retrospective analysis.
Patients Or Subjects:
None.
Setting:
In separate searches of ongoing phase II-IV clinical trials registered with ClinicalTrials.gov and funding grants available in the Canadian Institutes for Health Research funding decision database between 1999 and 2012, we identified all research initiatives focused on adult ICU patients.
Interventions:
None.
Measurements And Main Results:
The primary outcome of interest was the proportion of cardiac-specific ICU studies, defined as any involving a cardiac population with a cardiac intervention (or observation for observational analyses) and/or a cardiac outcome. A total of 192 unique studies including adult ICU patients were identified from the ClinicalTrials.gov database. These were most commonly classified as respiratory or ventilation (19%), infectious (14.1%), or neurologic (12.0%) in focus. A total of 105 grants were identified in the Canadian Institutes for Health Research database. Funded studies most commonly addressed respiratory or ventilator questions (18.1%), infectious disease issues (12.4%), or hematological/thrombosis questions (9.5%). Only 4.6% of all ICU studies in ClinicalTrials.gov and 1.9% of all Canadian Institutes for Health Research grants could be considered cardiac.
Conclusions:
These findings highlight the relative paucity of cardiac-specific research in the intensive care setting relative to the high prevalence of acute cardiac diseases and comorbidities. This observed disparity warrants timely attention and should lead to meaningful research opportunities aimed at improving the outcomes of critically ill cardiac patients.
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