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 real-world context to cardiovascular clinical research. Accordingly, the NCDR Research to Practice (previously known as the Rapid Registry Response) initiative was created.1
The goal for these analyses is to assist front-line cardiovascular clinicians in applying clinical research insights to their individual patients.
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.
- Maddox TM, Masoudi FA, Oetgen WJ, Rumsfeld JS. The capacity of evidence to inform practice: the rapid registry response (RRR) initiative. J Am Coll Cardiol 2015;65:2252-53.
- Committee on the Learning Health Care System in America; Institute of Medicine. Best Care at Lower Cost. The Path to Continuously Learning Health Care in America. Smith M, Saunders R, Stuckhardt L, McGinnis JM, eds. Washington, DC: National Academies Press (US); 2013. Available at: https://www.ncbi.nlm.nih.gov/books/NBK207225/. Accessed February 14, 2017.
- Gehi AK, O’Brien E, Pathak RK, et al. Implications of the LEGACY trial on US atrial fibrillation patients: an NCDR Research to Practice (R2P) project. Am J Cardiol 2017;119:579-84.
Keywords: ACC Publications, Cardiology Magazine, Cardiovascular Diseases, Diabetes Mellitus, Heart Diseases, Registries, National Cardiovascular Data Registries, Research, Evidence-Based Medicine
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