PCORI Answers Critical Questions
Evidence gaps can make it difficult to know which cardiovascular disease treatment will work best given a patient’s needs. PCORI funds studies that seek to help patients, clinicians and others answer various questions they might have about treatment options, such as:
Patient: I want to avoid having another deep-vein blood clot. Which of the many blood-thinning drugs would be most safe and effective for me over the long term?
Caregiver: My 85-year-old father is leaving the hospital after surviving a stroke. What drug would work best for him to avoid another hospital stay or need to go into a nursing home?
Clinician: How can I best help my patients in this small rural town get their blood pressure under control and avoid heart attacks and strokes?
Evidence for Decisions from PCORI-Funded Studies
|Evidence Updates: Reducing Risk of Stroke in Patients with Atrial Fibrillation
People with atrial fibrillation (AFib) have a higher risk for stroke compared with people who have a normal heart rhythm. Medicines that keep blood from clotting, called anticoagulants, lower the risk of stroke but can also cause serious bleeding. A recent review of research found that some newer anticoagulants do better at reducing the risk of stroke, and some also reduce the risk of serious bleeding compared to traditional therapies.
Study Results that Support Better-Informed Decisions
When heart failure occurs or gets worse suddenly, it’s called acute heart failure, or AHF. Researchers in a PCORI-funded study tested whether a self-care program with a coach supported patients with AHF after they left the emergency room more than usual care supported them. After 30 days, patients in the self-care program had fewer AHF-related deaths and visits to the emergency room, hospital, or clinic, and had higher ratings of their health than those who received usual care. However, these improvements did not hold 90 days after hospitalization. These results appeared in JAMA Cardiology.
The PCORI-funded PROSPER study compared outcomes of older adults who have atrial fibrillation and have had a stroke. In a new paper published in JAMA Neurology, the research team reports that patients who were prescribed direct oral anticoagulants when discharged from the hospital following a stroke had relatively better outcomes—including more days at home and fewer adverse events—than patients prescribed the blood thinner warfarin. This reinforces findings from prior research on the subject.
A heart implant called a left ventricular assist device (LVAD) can prolong the lives of people with severe heart failure, but it’s also associated with significant risk for harms, making choosing whether to have one implanted very difficult, according to an article in JAMA Internal Medicine. Using a shared decision making tool focused on LVAD improved patients’ knowledge about their treatment options and risks, this study found, and helped them make initial decisions better aligned with their values.
When patients at risk for developing a potentially fatal blood clot during a hospital stay missed a dose of drugs that can reduce this risk, receiving educational information about the drugs—through a conversation with a provider or a video or printed pamphlet—significantly increased the chances they got all their necessary doses, this study showed. The findings have been published in JAMA Network Open.
Although chest pain sends many people to emergency departments, a significant percentage are not having a heart attack or other serious heart problem. Patients who used a decision aid were more knowledgeable about their risk and care options and more involved in decisions about whether to be admitted to the hospital or go home, the Chest Pain Choice Trial found.
For at least one year after treatment, a nonsurgical method to replace a damaged heart valve was as safe as the surgery conventionally used in patients at moderate or high risk for surgical complications, this study determined. Moreover, compared with surgery, the nonsurgical approach allowed more patients to go directly home from the hospital, rather than to a nursing home or rehabilitation facility. That’s an outcome the study’s patient partners had identified as particularly important.
Cardiovascular Disease Study Spotlights
PCORI and the American Heart Association are partnering in innovative ways, including crowdsourcing, to help answer questions that matter to patients with atrial fibrillation.
This study is comparing the comfort, convenience, and effects on health when people with hypertension have their blood pressure measured in clinics, at home, at automated blood pressure measuring kiosks, and by wearing an arm cuff with a monitor for 24 hours.
About one in three American adults has hypertension, or high blood pressure (HBP). This study is comparing two methods of monitoring HBP to determine whether telehealth offers an edge over more traditional clinic-based care.