Cardiovascular Consortium Effective Health Care Program (Text Version)

Slide Presentation from the AHRQ 2008 Annual Conference

On September 8, 2008, Art Sedrakyan, M.D., Ph.D., made this presentation at the 2008 Annual Conference. Select to access the PowerPoint® presentation (2.2 MB).

Slide 1

Cardiovascular Consortium Effective Health Care Program

Art Sedrakyan, MD, PhD
Center for Outcomes & Evidence, AHRQ

Slide 2

Heart Disease is No. 1 Killer of Women

And Men Too...

The slide shows a silhouette of a woman's red dress stand with four black boxes in descending order with the title: "Leading Causes of Death for American Women (2000)".

• Heart Disease: 366,000—next to the silhouette.
• Stroke: 103,000—first black box.
• Lung Cancer: 65,000—second black box.
• Chronic Obstructive Pulmonary Disease (COPD): 62,000—third black box.
• Breast Cancer: 42,000—fourth black box.

Slide 3

Age Adjusted Death Rates in USA

Screen shot of a line graph showing the deaths per 100,000 of the population for Cardiovascular, Injury and Poisoning, Mental, Neoplasms, Endocrine, Musculoskeletal, Respiratory, and Digestive. The vertical axis goes from 0 to 450 and the horizontal axis shows the time period between 1989 and 2004. The line graph for Cardiovascular is the most prominent. It starts at 425 in 1989 and steadily lowers, reaching an end of 275 by 2004. The line graph for Neoplasms is the second most prominent, starting at 225 in 1989, and remaining relatively level, ending at 180 in 2004. The others all start and end under 100, remaining relatively even throughout the 15 year time period.

Source: National Institutes for Health (NIH), 2007, chartbook on morbidity and mortality.

Slide 4

Heart Disease Deaths

Screen shot of a map of the U.S. divided into states and counties, and color-coded with varying hues of red to represent "Age-Adjusted Average Annual Deaths per 100,000." The source of the map is the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion and the National Vital Statistics System, U.S. Census Bureau, July 2006.

Slide 5

Screen shot of a cartoon showing a newsman on air stating, "According to a report released today...", sitting in front of three spinners with the headline reading, "Today's Random Medical News from the New England Journal of Panic-Inducing Gobbledygook." The first spinner shows smoking, exercise, fatty foods, stress, red wine, daycare, computer terminals, and coffee. These "Can Cause", leading to the second spinner, heart disease, breast cancer, spontaneous remission, glaucoma, depression, sexual dysfunction, a feeling of well-being, or hypothermia. "In", leading to the third spinner, children, twins, arthritis sufferers, 7 out of 10 women, rats, over-weight smokers, men 25-40, and two-income families.

Slide 6

Effective Health Care Program

Congress authorized AHRQ (section 1013 of the Medicare Modernization Act [MMA]) to conduct research to improve the quality, effectiveness, and efficiency of Medicare and Medicaid programs.

1. Evidence synthesis (Evidence-based Practice Center [EPC] program):
   • Transparent process of systematically reviewing and synthesizing evidence on treatment effectiveness.
   • Identifying relevant knowledge gaps.
2. Evidence generation (Developing Evidence to Inform Decisions about Effectiveness [DEcIDE] and Centers for Education and Research on Therapeutics [CERTs]):
   • Development of new scientific knowledge to address knowledge gaps.
3. Evidence translation (Eisenberg Center):
   • Communication of scientific information in plain language to policymakers, patients, and providers.

Slide 7

Effective Healthcare Program

Screen shot showing the homepage from AHRQ's Effective Health Care (EHC) Web site.

Slide 8

Lifecycle of Cardiovascular (CV) Initiative

Flowchart showing the lifecycle:

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

Slide 9

Cardiovascular consortium: Comparative Effectiveness Reviews (CER)

Inform decision makers and identify the gaps in knowledge.

Completed:

• Comparative Effectiveness of percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) for coronary artery disease (CAD).
• CER of Management Strategies for Renal Artery Stenosis.
• CER of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) for hypertension (HT).

In progress:

• CER of Combinations of Lipid-Modifying Agents.
• CER of Medical Therapies with or without ACEs or ARBs for Stable CAD.
• Effectiveness and Off-label Use of Recombinant Factor VIIa.
• Effectiveness of Radiofrequency Catheter Ablation (RFA) for Atrial Fibrillation.
• Technical Brief: Percutaneous Heart Valves.

Slide 10

Cardiovascular consortium: Generating new evidence

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:
https://effectivehealthcare.ahrq.gov

Slide 11

Our plan for today

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