Thomas M. Maddox MD, MSC, FACC and Robert W. Yeh MD, FACC 2017-03-07 05:02:34
Applying Clinical Research to Clinical Practice: The NCDR Research to Practice Initiative Evidence-based practice has long been a guiding principle of cardiovascular care. As a specialty, cardiology has been at the forefront of clinical research, conducting randomized controlled trials and other clinical investigations to ensure the capacity to offer proven treatments to patients for their cardiac disease. However, the relevance of clinical research to contemporary practice patterns and patient need is variable. For example, many clinical trials primarily enroll patients who are Caucasian and male, and thus are unable to verify that the studied treatments are efficacious in less well-represented populations. Similarly, the significant time inherent in designing, funding and conducting clinical trials means that secular shifts in underlying patient populations and treatment patterns may render the insights from these trials less germane to contemporary practice. Finally, as the cardiac population ages, many patients will be affected by multiple co-morbidities. Most clinical research excludes patients with significant co-morbidity, and therefore cannot provide insight into significant portions of current cardiac populations. Understanding the relevance of clinical research to clinical practice can be accomplished by assessing research insights in the context of contemporary cardiac patients and treatment patterns. This context can be provided by large, comprehensive clinical registries. The ACC maintains the world’s largest collection of cardiovascular clinical registries through its NCDR program, and is well positioned to provide realworld context to cardiovascular clinical research. Accordingly, the NCDR Research to Practice (previously known as the Rapid Registry Response) initiative was created.1 The Research to Practice (R2P) initiative identifies impactful cardiovascular research and analyzes its implications for contemporary clinical practice using ACC’s NCDR clinical registries. The goal for these analyses is to assist front-line cardiovascular clinicians in applying clinical research insights to their individual patients. For example, analyses can ask “How similar are my patients to those enrolled in a major clinical trial?” or “How large an impact would the study’s findings have on today’s practice?” Furthermore, these analyses can identify relevant questions in contemporary practice that are unanswered by current clinical research data, and thus inform clinical researchers of important questions for future investigation. This iterative “conversation” between practice and research, facilitated by the R2P initiative, is a foundational concept of the “learning health care system” vision advanced by the National Academy of Medicine.2 The R2P initiative was founded in 2015 by Thomas M. Maddox MD, Msc, FACC, with support from NCDR leaders John S. Rumsfeld MD, PhD, FACC, and Frederick A. Masoudi MD, MSPH, FACC. Under the oversight of the R2P committee, chaired by Robert W. Yeh MD, FACC, eight recent cardiovascular clinical studies or evidence covering the spectrum of cardiovascular disease were identified and analyzed using their relevant NCDR clinical registry. As of press time, six projects have been accepted at national or international cardiology and diabetes conferences (including three at the ACC’s 2017 Annual Scientific Session) and one project has been published in a peer-reviewed cardiology journal (TABLE).3 With this promising beginning, the R2P initiative is poised to serve as an important tool for understanding the relevance of clinical research to clinical practice, and ensuring that our investment into clinical research speaks directly to the current needs of cardiovascular patients. NCDR.17: Helping Hospitals Optimize Quality Nearly 1,600 professionals are expected at NCDR.17 to learn quality improvement best practices, sharpen and learn new skills, and network. This year’s annual conference will be held March 13-15 at the Gaylord Resort and Convention Center in Washington, DC. “A key benefit of attending NCDR.17 is a deeper understanding of NCDR and how it can facilitate the capacity of hospitals and health systems to optimize their quality,” said Frederick A. Masoudi, MD, FACC, chair of the NCDR Management Board and NCDR chief science officer. Robert M. Califf, MD, MACC, a champion of the value of real-world evidence, particularly from professional registries such as NCDR, will kick off the conference by giving the Ralph G. Brindis Endowed Keynote Lecture. Ben Harder, who oversees the Best Hospitals rankings at U.S. News & World Report, and who was recently recognized as one of the 60 most powerful people in health care in 2016 by Becker’s Hospital Review, is one of several other notable speakers throughout the three-day conference. Registry-specific concurrent workshops throughout the conference will allow conference participants to deep-dive into individual registries and provide updates and opportunities to discuss data quality issues. Two pre-conference workshops on March 13 will introduce participants to the new LAAO Registry and provide an overview of NCDR for those new to the conference and ACC registries in general. New this year, two pre-conference workshops on Cath Lab and Chest Pain accreditation, led by ACC Accreditation Services, will also take place. The contribution of registry data to achieving accreditation and the synergy between the mission and values of NCDR and ACC Accreditation Services made this a natural evolution within the meeting, said Ralph G. Brindis, MD, MPH, MACC, co-chair of NCDR.17. Want more NCDR? Search “NCDR” in the ACC.17 app for relevant sessions. Nearly 20 abstracts using data from NCDR registries will be presented at ACC.17.
Published by American College of Cardiology. View All Articles.
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