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"cardiovascular disease"

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This slide set is based on a comparative effectiveness review (CER) titled, Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors (ACEIs) or Angiotensin II-Receptor Blockers (ARBs) Added to Standard Medical Therapy for Treating Stable Ischemic Heart Disease (IHD), that was developed by the University of Connecticut/Hartford Hospital Evidence-based Practice Center for the Agency for Healthcare Research and Quality (AHRQ) and is available online at effectivehealthcare.ahrq.gov (Contract No. 290-2007-10067-I). CERs represent comprehensive systematic reviews of the literature usually comparing two or more types of treatment, such as different drugs, for the same disease. Primary clinical trials were identified from searches of MEDLINE (1966 to February 2009), Embase (1974 to February 2009), and the Cochrane Central Register of Controlled Trials (1966 to February 2009). The methods used to develop this CER followed version 1.0 of the Methods Reference Guide for Effectiveness and Comparative Effectiveness Reviews published by AHRQ (draft available at: http://effectivehealthcare.ahrq.gov/repFiles/2007_10DraftMethodsGuide.pdf). The talk will cover the current evidence on the burden of cardiovascular disease in the U.S. followed by the available statistics and characteristics of the target population, patients with stable ischemic heart disease (IHD) and preserved left ventricular systolic function (LVSF). We will briefly discuss the comparative effectiveness review process, including the specific questions addressed in this CER and the results from this research. Finally, the benefits and harms of each treatment modality are presented in such a way as to promote doctor-patient communication in order to facilitate an informed decisionmaking process.
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Outline of Material

Presentation: 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
Keywords: effective health care | informed decisionmaking | key questions | comparative effectiveness
An estimated 80 million American adults (1 in 3) have one or more forms of cardiovascular disease. Among these adults, 38,100,000 are estimated to be age 60 or older, and about 16.8 million adults have ischemic heart disease, also known as coronary heart disease.
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Health Impact of Cardiovascular Disease in the United States (1)

Presentation: 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
Keywords: cardiovascular disease | coronary heart disease | ischemic heart disease | health impact
Cardiovascular disease has been the leading cause of death in the United States in every year since 1900, except in 1918, accounting for more deaths than any other single cause or group of causes of death. Cardiovascular disease claims more lives each year than cancer, chronic lower respiratory diseases, accidents, and diabetes mellitus combined. According to current data, nearly 2,400 Americans die of cardiovascular disease each day, an average of 1 death every 37 seconds.
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Health Impact of Cardiovascular Disease in the United States (2)

Presentation: 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
Keywords: cardiovascular disease | ischemic heart disease | health impact
The Telmisartan Randomized Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease (TRANSCEND) trial (Yusuf et al., 2008) was the only trial that met the inclusion criteria for the addition of an angiotensin II receptor blocker (ARB) to standard medical therapy for patients with stable ischemic heart disease (IHD) and preserved left ventricular function (LVSF) as compared to standard medical therapy alone or with a placebo. Patients who could not tolerate angiotensin-converting enzyme inhibitors (ACEIs) were enrolled in the study and were treated with telmisartan. The results of this trial showed that the difference in event rates between the two treatment groups to be less than 2. On average, 56 patients who have stable IHD and preserved LVSF and cannot tolerate ACEIs will need to be treated with an ARB over 5 years to prevent one or more of the following events: cardiovascular death, nonfatal myocardial infarction, or stroke. In other words, on average, 14.8 of every 100 patients will experience one or more of these cardiovascular events in the next 5 years. If an ARB were to be added to the treatment regimens of 100 patients, 13 of them would have a risk of suffering one or more of these cardiovascular events. The relative risk reduction in the combined risk for cardiovascular death, nonfatal myocardial infarction, or stroke is 12%. All of these data were determined to be at a high level of evidence, meaning that future trials are unlikely to change the estimated differences between these treatment groups.
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Benefits With HIGH Levels of Evidence That Result From Adding an ARB to Standard Medical Therapy for Stable Ischemic Heart Disease With Preserved Left Ventricular Systolic Function*

Presentation: 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
Keywords: evidence-based benefits | number needed to treat | relative risk | stable ischemic heart disease | angiotensin II-receptor blocker
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Background: Complications

Presentation: Comparing Medications for Adults With Type 2 Diabetes
Keywords: type 2 diabetes | complications | cardiovascular disease | kidney disease | retinopathy | neuropathy | nephropathy
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Rationale for Update

Presentation: Comparing Medications for Adults With Type 2 Diabetes
Keywords: comparative effectiveness review | systematic review | type 2 diabetes | noninsulin injectables | DPP-4 inhibitors | medications for type 2 diabetes
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Intermediate Outcomes: Overview of Lipid Results

Presentation: Comparing Medications for Adults With Type 2 Diabetes
Keywords: intermediate outcomes | lipid results | high-density lipoprotein | low-density lipoprotein | triglycerides | antidiabetic medication
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Macrovascular and Microvascular Long-Term Clinical Outcomes of Diabetes

Presentation: Comparing Medications for Adults With Type 2 Diabetes
Keywords: macrovascular | microvascular | long-term outcomes | mortality | cardiovascular mortality | morbidity
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Long-Term Clinical Outcomes: Overview

Presentation: Comparing Medications for Adults With Type 2 Diabetes
Keywords: long-term clinical outcomes | mortality | morbidity | cardiovascular disease | nephropathy
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Disease Risk Scores

Presentation: Considerations for Statistical Analysis in Observational Comparative Effectiveness Research
Keywords: disease risk scores
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Causal Models and the Structural Relationship of Variables (3 of 7)

Presentation: Covariate Selection for Observational Comparative Effectiveness Research
Keywords: causal models | intermediate variables
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Background: Adverse Clinical Outcomes Associated With Obstructive Sleep Apnea

Presentation: Diagnosis and Treatment of Obstructive Sleep Apnea in Adults
Keywords: background | comorbidity | epidemiology | outcomes | public health impact
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