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Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors and/or Angiotensin II Receptor Blockers Added to Standard Medical Therapy for Treating Patients With Stable Ischemic Heart Disease and Preserved Left Ventricular Systolic Function

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The CER Development Process

The comparative effectiveness review topic, Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors or Angiotensin II-Receptor Blockers Added to Standard Medical Therapy for Treating Stable Ischemic Heart Disease, was nominated in a public process. Sufficient research into the current literature determined that there was a need for the available evidence on the addition of ACEIs and ARBs to standard medical therapy for patients with stable ischemic heart disease and preserved left ventricular systolic function (LVSF) and that there was an adequate number of clinical trials to be included in a comparative effectiveness review (CER). Based on this research, the Agency for Healthcare Research and Quality (AHRQ) commissioned the University of Connecticut/Hartford Hospital Evidence-Based Practice Center to prepare the CER with input from a Technical Expert Panel. This advisory panel was comprised of experts in different specialties, including cardiologists, a cardiovascular pharmacist/pharmacologist, and a health policy pharmacist. The panel identified important issues, reviewed proposed methods, defined parameters for the review of evidence, and helped to refine the key clinical questions that the research would subsequently address. Once formulated, the key clinical questions were published online and were made available for public commentary in order to refine the scope and focus of the research questions. A comprehensive systematic review of the literature was then conducted using several well-known databases, including MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. All methods used in the review followed version 1.0 of AHRQ’s Methods Reference Guide for Effectiveness and Comparative Effectiveness Reviews (available at: http://effectivehealthcare.ahrq.gov/repFiles/2007_10DraftMethodsGuide.pdf) and the trial end points were determined a priori. Based on the findings of the review, a draft CER was prepared and published online for public comment, and the draft underwent rigorous peer review to improve the final product. After the CER was finalized, the complete report was published on the Internet (available at: http://effectivehealthcare.ahrq.gov/ehc/products/57/335/bodyfinal.pdf) and a condensed version was published in the Annals of Internal Medicine (available at: http://www.annals.org/content/early/2009/10/19/0003-4819-151-12-200912150-00162.full).