Cardiovascular Consortium Effective Health Care Program Art Sedrakyan, MD, PhD Center for Outcomes & Evidence, AHRQ

Heart Disease is No. 1 Killer of Women And Men Too… And Men Too…

Age Adjusted Death Rates in USA National NIH 2007, chartbook on morbidity and mortality

Heart Disease Deaths

Effective Health Care Program Congress authorized AHRQ (section 1013 of MMA) to conduct research to improve the quality, effectiveness, and efficiency of Medicare and Medicaid programs. A. Evidence synthesis (EPC program) – Transparent process of systematically reviewing and synthesizing evidence on treatment effectiveness – Identifying relevant knowledge gaps B. Evidence generation (DECIDE and CERTS) – Development of new scientific knowledge to address knowledge gaps C. Evidence translation (Eisenberg Center) – Communication of scientific information in plain language to policymakers, patients, and providers 6

Effective Healthcare Program

Lifecycle of CV initiative CV topic solicitation (public input) CV topic generation ( work with stakeholders) CV topic Nominated ( work with stakeholders) Not enough information work with stakeholder Enough information evaluate if all EHC criteria are met EHC Criteria are not met Need to generate new evidence (use DECIDE, CERT, other) Admin/Claims based study Registry (linked) based study New data collection Need evidence review (use EPC) General Comparative Technical brief

Cardiovascular consortium: Comparative Effectiveness Reviews (CER) Inform decision makers and identify the gaps in knowledge Completed Comparative Effectiveness of PCI and CABG for CAD Comparative Effectiveness of PCI and CABG for CAD CER of Management Strategies for Renal Artery Stenosis CER of Management Strategies for Renal Artery Stenosis CER of ACEIs and ARBs for Hypertension CER of ACEIs and ARBs for Hypertension In progress CER of Combinations of Lipid-Modifying Agents CER of Combinations of Lipid-Modifying Agents CER of Medical Therapies with or without ACEs or ARBs for Stable CAD CER of Medical Therapies with or without ACEs or ARBs for Stable CAD Effectiveness and Off-label Use of Recombinant Factor VIIa Effectiveness and Off-label Use of Recombinant Factor VIIa Effectiveness of Radiofrequency Catheter Ablation (RFA) for Atrial Fibrillation Effectiveness of Radiofrequency Catheter Ablation (RFA) for Atrial Fibrillation Technical Brief: Percutaneous Heart Valves Technical Brief: Percutaneous Heart Valves

Cardiovascular consortium: Generating new evidence New direction with Main emphasis on using national registries and their linkages in comparative effectiveness research New direction with Main emphasis on using national registries and their linkages in comparative effectiveness research – The role of National Clinical Registries in the Cycle of Evidence – National registry based study to evaluate effectiveness of Drug Eluting Stents and optimal length of anticoagulation therapy – National registry based study of effectiveness of cardiac valve implants – Other local registry or claims based studies List of previous contributing studies at

Our plan for today CABG vs PCI: Evidence in evolution: CABG vs PCI: Evidence in evolution: Professor Mark Hlatky Stanford University Clinical Registries in the Cycle of Evidence Clinical Registries in the Cycle of Evidence Professor Eric Peterson Duke University Questions to presenters and discussion Questions to presenters and discussion