Annals of Internal Medicine tip sheet for July 31, 2012 online issue

Coronary heart disease (CHD) is the leading cause of death in the United States for both men and women. Certain physical and lifestyle characteristics increase risk for CHD, yet some low-risk patients may suffer a CHD event without warning. Electrocardiogram (ECG) can detect abnormalities that may predict a future CHD event. However, in 2004, the United Sates Preventive Services Task Force found a lack of evidence that ECG screening in asymptomatic, low-risk adults improves health outcomes. Subsequently the Task Force recommended against routine ECG screening for asymptomatic adults at low risk for CHD. To update its previous recommendation, the Task Force reviewed new research published since its 2004 recommendation to compare the benefits and harms of screening asymptomatic adults with ECG with no screening at reducing the risk for CHD events. The researchers also looked at how identifying high-risk individuals affected treatment to reduce risk, and the accuracy of risk-stratification. The Task Force found that while ECG could detect abnormalities that are associated with an increased risk for a serious CHD event, screening asymptomatic, low-risk adults was highly unlikely to result in changes in risk stratification that would prompt interventions that would eventually reduce CHD events. The Task Force found adequate evidence that screening this population leads to at least small harms such as unnecessary invasive procedures, overtreatment, and labeling. Therefore, the Task Force continues to recommend against screening ECG for asymptomatic, low-risk adults.

The Agency for Healthcare Research and Quality (AHRQ) Evidence-based Practice Center (EPC) Program is an ongoing, federally-funded initiative to develop evidence reports and technology assessments on health care topics that affect a large portion of the population. Topics for research are nominated by non-federal partners such as professional societies, health plans, insurers, employers, and patient groups. Subsequently, clinical guidelines and recommendations are developed with the goal of helping patients, clinicians, payers, and policy makers make good health care decisions that are based on reliable evidence. At times, there are gaps in the research that prevent systematic reviewers from answering central questions. These gaps may include insufficient studies on sub-populations, insufficient studies with appropriate comparators, lack of appropriate outcomes measured, and/or methods problems. Using five principles developed to guide a research agenda setting process, the AHRQ EPC program identified several topic areas where future research is needed. These include gestational diabetes; integration of mental health/substance abuse in primary care; reducing the risk for primary breast cancer; clinically localized prostate cancer; and ADHD, among other common or costly health care issues.* According to the author, the AHRQ hopes that this approach to assessing the need for future research will help other groups interested in engaging stakeholders in prioritizing research.

*A full list of topics is included in the article tables, available upon request

The Patient-Centered Outcomes Research Institute, or PCORI, advocates for the role of patients in research and considers the importance of their perspective in the development of research programs. With funds from the Patient Protection and Affordable Care Act, PCORI will invest $3 billion between now and 2019 in research intended to improve health care decision-making. As part of PCORI's National Priorities, it will award $96 million for proposals of comparative effectiveness research in the areas of prevention, diagnosis, and treatment options for patients; improvements of health care systems; communication and dissemination research; and disparity reduction or elimination strategies. According to PCORI leaders, patient-centered research should focus on areas that will directly affect patients and their caregivers, resulting in greater understanding of their conditions, the benefits and harms of treatments available to them, and how to get the best care. PCORI funding announcements are communicated in a way that promotes collaboration. Four key concepts guide PCORI in its effort to support patient-centered research. According to the authors, PCORI uses research to inform, not dictate decisions; it calls for applications through grassroots efforts; it considers patients to be partners in the research, and not just subjects; and it is dedicated to the dissemination, adoption, and successful application of the research as well as promotion of the strongest science.