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Duncan A, Shiely F. Analysis of core outcome set reporting in coronary intervention trials. Open Heart 2024; 11:e002581. [PMID: 38688715 PMCID: PMC11086530 DOI: 10.1136/openhrt-2023-002581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/15/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND This paper will focus on outcome reporting within percutaneous coronary intervention (PCI) trials. A core outcome set (COS) is a standardised set of outcomes that are recommended to be reported in every clinical trial. Using a COS can help to ensure that all relevant outcomes are consistently reported across clinical trials. In 2018, the European Society of Cardiology outlined the only COS published for PCI trials. METHODS We searched the literature for all randomised controlled trials published between 2014 and 2022. PCI trials included were late-phase trials and must investigate coronary intervention. The primary outcome was the proportion of trials that reported all of the COS-defined outcomes within their publication as either a primary, secondary or safety endpoint. The secondary outcomes included; the number of primary outcomes reported per study, the proportion of studies which use patient and public involvement (PPI) during trial design, outcome variability and outcome consistency. RESULTS 9580 trials were screened and 115 studies met inclusion/exclusion criteria. Our study demonstrated that 55% (34/62) of PCI trials used a COS when it was available, compared with 40% (21/53) before the availability of a PCI COS set, p=0.121. Fewer primary outcomes were reported after the implementation of the COS, 2 compared with 2.3, p=0.014. There was no difference in the use of PPI between either group. There was a higher level of variability in outcomes reported before the availability of the COS, while the consistency of outcome reporting remained similar. CONCLUSION The use of a COS in PCI trials is low. This study provides evidence that there still is a lack of awareness of the COS among those who design clinical trials. We also presented the inconsistency and heterogenicity in reporting clinical trial outcomes. Finally, there was a clear lack of PPI utilisation in PCI trials.
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Affiliation(s)
- Aaron Duncan
- University College Cork, Cork, Ireland
- Beaumont Hospital, Dublin, Ireland
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Fu Y, Tang EY, Sowden S, Newton JL, Whitty P. Tailoring lipid management interventions to reduce inequalities in cardiovascular disease risk management in primary care for deprived communities in Northern England: a mixed-methods intervention development protocol. BMJ Open 2022; 12:e058951. [PMID: 35788081 PMCID: PMC9255393 DOI: 10.1136/bmjopen-2021-058951] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Hyperlipidaemia contributes a significant proportion of modifiable cardiovascular disease (CVD) risk, which is a condition that disproportionally affects disadvantaged socioeconomic communities, with death rates in the most deprived areas being four times higher than those in the least deprived. With the national CVD Prevention programme being delivered to minimise risk factors, no evidence is available on what has been implemented in primary care for deprived populations. This study describes the protocol for the development of a tailored intervention aiming to optimise lipid management in primary care settings to help reduce inequalities in CVD risks and improve outcomes in deprived communities. METHODS AND ANALYSIS A mixed-methods approach will be employed consisting of four work packages: (1) rapid review and logic model; (2) assessment and comparison of CVD risk management for deprived with non-deprived populations in Northern England to England overall; (3) interviews with health professionals; and (4) intervention development. A systematic search and narrative synthesis will be undertaken to identify evidence-based interventions and targeted outcomes in deprived areas. General practice-level data will be assessed to establish the profile of lipid management, compared with the regional and national levels. Health professionals involved in the organisation and delivery of routine lipid management to deprived populations will be interviewed to understand the implementation and delivery of current lipid management and associated challenges. The prototype intervention will be informed by the evidence generated from workpackages 1-3, which will be reviewed and assessed using the nominal group technique to reach consensus. Training and skills development materials will also be developed as needed. ETHICS AND DISSEMINATION Ethics approval has been obtained from the Faculty of Medical Sciences Research Ethics Committee at Newcastle University, UK. Findings will be disseminated to the participating sites, participants, commissioners, and in peer-reviewed journals and academic conferences.
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Affiliation(s)
- Yu Fu
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- NIHR Applied Research Collaborative North East and North Cumbria, Cumbria, Northumberland and Tyne and Wear NHS Foundation Trust, Newcastle upto Tyne, UK
| | - Eugene Yh Tang
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah Sowden
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Julia L Newton
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Academic Health Science Network for the North East and North Cumbria, Newcastle upon Tyne, UK
| | - Paula Whitty
- NIHR Applied Research Collaborative North East and North Cumbria, Cumbria, Northumberland and Tyne and Wear NHS Foundation Trust, Newcastle upto Tyne, UK
- North East Quality Observatory Service, Cumbria Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
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Development of the International Cardiac Rehabilitation Registry Including Variable Selection and Definition Process. Glob Heart 2022; 17:1. [PMID: 35174042 PMCID: PMC8757385 DOI: 10.5334/gh.1091] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 12/15/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction: The International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) is developing a registry (ICRR) specifically for low-resource settings, where the burden of cardiovascular diseases is greatest and the need for program development highest. Herein we describe the development process, including the variable selection process. Method: Following a literature search on registry best practices, a stepwise model for ICRR development was identified. Then, based on recommendations by Core Outcome Set-STAndards for Development (COS-STAD), we underwent a process to identify variables. All available CR registries were contacted to request their data dictionaries, reviewed CR quality indicators and guideline recommendations, and searched for common data elements and core outcome sets; 35 unique variables (including patient-reported outcomes) were selected for potential inclusion. Twenty-one purposively-identified stakeholders and experts agreed to serve on a Delphi panel. Panelists rated the variables in an online survey, and suggested potential additional variables; A webcall was held to reach consensus on which to include/exclude. Next, panelists provided input to finalize each variable definition, and rated which associated indicators should be used for benchmarking in registry dashboards and a patient lay summary; a second consensus call was held. A 1-month public comment period ensued. Results: First, registry objectives and governance were approved by ICCPR, including data quality and access policies. The protocol was developed, for public posting. For variable selection, the overall mean rating was 6.1 ± 0.3/7; 12 were excluded, some of which were moved to a program survey, and others were revised. Two variables were added in an annual follow-up, resulting in 13 program and 16 patient-reported variables. Legal advice was sought to finalize ICRR agreements. Ethics approvals were obtained. Usability testing is now being initiated. Conclusion: It is hoped this will serve to harmonize CR assessment internationally and enable quality improvement in CR delivery in low-resource settings.
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Whiteley WN, Anand S, Bangdiwala SI, Bosch J, Canavan M, Chertkow H, Gerstein HC, Gorelick P, O’Donnell M, Paré G, Pigeyre M, Seshadri S, Sharma M, Smith EE, Williamson J, Cukierman-Yaffe T, Hart RG, Yusuf S. Are large simple trials for dementia prevention possible? Age Ageing 2020; 49:154-160. [PMID: 31830268 PMCID: PMC7047819 DOI: 10.1093/ageing/afz152] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 07/30/2019] [Indexed: 01/09/2023] Open
Abstract
New trials of dementia prevention are needed to test novel strategies and agents. Large, simple, cardiovascular trials have successfully discovered treatments with moderate but worthwhile effects to prevent heart attack and stroke. The design of these trials may hold lessons for the dementia prevention. Here we outline suitable populations, interventions and outcomes for large simple trials in dementia prevention. We consider what features are needed to maximise efficiency. Populations could be selected by age, clinical or genetic risk factors or clinical presentation. Patients and their families prioritise functional and clinical outcomes over cognitive scores and levels of biomarkers. Loss of particular functions or dementia diagnoses therefore are most meaningful to participants and potential patients and can be measured in large trials. The size of the population and duration of follow-up needed for dementia prevention trials will be a major challenge and will need collaboration between many clinical investigators, funders and patient organisations.
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Affiliation(s)
- William N Whiteley
- Centre for Clinical Brain Sciences, University of Edinburgh, UK
- Nuffield Department of Population Health, University of Oxford, UK
| | - Sonia Anand
- Population Health Research Institute, McMaster University & Hamilton Health Sciences, Canada
| | - Shrikant I Bangdiwala
- Population Health Research Institute, McMaster University & Hamilton Health Sciences, Canada
| | - Jackie Bosch
- Population Health Research Institute, McMaster University & Hamilton Health Sciences, Canada
| | - Michelle Canavan
- Department of Medicine, National University of Galway, Republic of Ireland
| | - Howard Chertkow
- Department of Medicine (Neurology), University of Toronto, Canada
- Rotman Research Institute, Baycrest Health Sciences, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Canada
- Department of Neurology and Neurosurgery, McGill University, Canada
| | - Hertzel C Gerstein
- Population Health Research Institute, McMaster University & Hamilton Health Sciences, Canada
- Division of Endocrinology and Metabolism, McMaster University, Canada
| | - Philip Gorelick
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, USA
- Department of Translational Neuroscience, Michigan State University College of Human Medicine and Mercy Health Hauenstein Neurosciences, USA
| | - Martin O’Donnell
- Department of Medicine, National University of Galway, Republic of Ireland
| | - Guillaume Paré
- Population Health Research Institute, McMaster University & Hamilton Health Sciences, Canada
| | - Marie Pigeyre
- Population Health Research Institute, McMaster University & Hamilton Health Sciences, Canada
| | - Sudha Seshadri
- The Framingham Study, Framingham, MA, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Sciences Center, USA
| | - Mike Sharma
- Population Health Research Institute, McMaster University & Hamilton Health Sciences, Canada
| | - Eric E Smith
- Hotchkiss Brain Institute, University of Calgary, Canada
| | - Jeff Williamson
- Section of Gerontology and Geriatric Medicine and the Sticht Center for Healthy Aging and Alzheimer’s Prevention, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Tali Cukierman-Yaffe
- Endocrinology & Metabolism Division, Sheba Medical Center, Israel
- Epidemiology Department, Sackler School of Medicine, Herczeg Institute on Aging, Tel-Aviv University, Israel
| | - Robert G Hart
- Population Health Research Institute, McMaster University & Hamilton Health Sciences, Canada
| | - Salim Yusuf
- Population Health Research Institute, McMaster University & Hamilton Health Sciences, Canada
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Sherratt FC, Brown SL, Haylock BJ, Francis P, Hickey H, Gamble C, Jenkinson MD, Young B. Challenges Conveying Clinical Equipoise and Exploring Patient Treatment Preferences in an Oncology Trial Comparing Active Monitoring with Radiotherapy (ROAM/EORTC 1308). Oncologist 2020; 25:e691-e700. [PMID: 32045067 PMCID: PMC7160418 DOI: 10.1634/theoncologist.2019-0571] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 12/31/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Providing balanced information that emphasizes clinical equipoise (i.e., uncertainty regarding the relative merits of trial interventions) and exploring patient treatment preferences can improve informed consent and trial recruitment. Within a trial comparing adjuvant radiotherapy versus active monitoring following surgical resection for an atypical meningioma (ROAM/EORTC-1308), we explored patterns in communication and reasons why health practitioners may find it challenging to convey equipoise and explore treatment preferences. MATERIALS AND METHODS Qualitative study embedded within ROAM/EORTC-1308. Data were collected on 40 patients and 18 practitioners from 13 U.K. sites, including audio recordings of 39 patients' trial consultations, 23 patient interviews, and 18 practitioner interviews. Qualitative analysis drew on argumentation theory. RESULTS Practitioners acknowledged the importance of the research question that the trial aimed to answer. However, they often demonstrated a lack of equipoise in consultations, particularly with eligible patients who practitioners believed to be susceptible to side effects (e.g., cognitive impairment) or inconvenienced by radiotherapy. Practitioners elicited but rarely explored patient treatment preferences, especially if a patient expressed an initial preference for active monitoring. Concerns about coercing patients, loss of practitioner agency, and time constraints influenced communication in ways that were loaded against trial participation. CONCLUSIONS We identified several challenges that practitioners face in conveying equipoise and exploring patient treatment preferences in oncology, and particularly neuro-oncology, trials with distinct management pathways. The findings informed communication about ROAM/EORTC-1308 and will be relevant to enhancing trial communication in future oncology trials. Qualitative studies embedded within trials can address difficulties with communication, thus improving informed consent and recruitment. ROAM/EORTC-1308 RCT: ISRCTN71502099. IMPLICATIONS FOR PRACTICE Oncology trials can be challenging to recruit to, especially those that compare treatment versus monitoring. Conveying clinical equipoise and exploring patient treatment preferences can enhance recruitment and patient understanding. This study focused on the challenges that practitioners encounter in trying to use such communication strategies and how practitioners may inadvertently impede patient recruitment and informed decision making. This article provides recommendations to support practitioners in balancing the content and presentation of trial management pathways. The results can inform training to optimize communication, especially for neuro-oncology trials and trials comparing markedly different management pathways.
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Affiliation(s)
- Frances C. Sherratt
- Institute of Population Health Sciences, University of LiverpoolUnited Kingdom
| | - Stephen L. Brown
- Institute of Population Health Sciences, University of LiverpoolUnited Kingdom
| | | | - Priya Francis
- Liverpool Clinical Trials Centre, University of LiverpoolUnited Kingdom
| | - Helen Hickey
- Liverpool Clinical Trials Centre, University of LiverpoolUnited Kingdom
| | - Carrol Gamble
- Liverpool Clinical Trials Centre, University of LiverpoolUnited Kingdom
| | - Michael D. Jenkinson
- Institute of Translational Medicine, University of LiverpoolUnited Kingdom
- The Walton Centre NHS Foundation TrustLiverpoolUnited Kingdom
| | - Bridget Young
- Institute of Population Health Sciences, University of LiverpoolUnited Kingdom
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