Future research prioritization in cardiac resynchronization therapy.
Marat Fudim1, Frederik Dalgaard2, Sana M Al-Khatib3
1Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Division of Cardiology, Duke University School of Medicine, Durham, NC.
American Heart Journal
|March 13, 2020
Summary
Cardiac resynchronization therapy (CRT) research needs further investigation for heart failure patients. Key evidence gaps include comorbidities, atrial fibrillation, and patient subgroups to optimize CRT effectiveness.
Area of Science:
- Cardiology
- Medical Devices
- Clinical Research
Background:
- Cardiac resynchronization therapy (CRT) benefits select patients with heart failure and reduced ejection fraction (HFrEF).
- Significant evidence gaps persist regarding CRT's clinical and policy implications.
Purpose of the Study:
- To review existing data on CRT for HFrEF patients on pharmacological therapy, with or without an implantable cardioverter-defibrillator (ICD).
- To identify and prioritize evidence gaps through stakeholder consensus, developing a future research agenda.
Main Methods:
- Systematic literature search of PubMed, EMBASE, and clinicaltrials.gov.
- Stakeholder-driven forced-ranking prioritization to identify and rank critical evidence gaps.
- Inclusion of diverse stakeholders: investigators, patients, public, industry, and policymakers.
Main Results:
- Identified 18 top-tier evidence gaps concerning CRT in HFrEF.
- Key gaps focus on specific populations (8), comparative effectiveness/safety (7), and treatment outcomes (3).
- Highest-ranked gaps involve comorbidities, atrial fibrillation, and CRT/ICD effectiveness by gender and QRS characteristics.
Conclusions:
- This review highlights critical, unresolved clinical and policy questions regarding CRT in HFrEF.
- The identified gaps provide a roadmap for future collaborative research to advance CRT understanding and application.
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