Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

1. What are the benefits and harms of rhythm control compared to rate control

(including newer agents) ? What are the benefits and harms of strict vs more lenient rate control? 2. What are the benefits and harms of different anticoagulation and antiplatelet agents and monitoring strategies for stroke prevention in patients in chronic atrial fibrillation? How do benefits and harms differ in specific patient populations (e.g. paroxysmal vs. chronic AF, younger vs. older, structural heart dz vs. not; common comorbidities vs. not)? What are the accuracy and utility of methods of risk stratification to guide choice of therapy (e.g. aspirin vs. warfarin)? 3. What are the benefits and harms of agents used for ventricular rate control in AF (including newer agents)? 4. What are the benefits and harms of antiarrythmic agents for acute conversion of AF to sinus rhythm (including newer agents)? 5. What are the benefits and harms of pharmacologic treatment of AF before electrical cardioversion (including newer agents)? 6. What are the benefits and harms of antiarrthymic agents for the maintenance of sinus rhythm after successful conversion of atrial fibrillation to sinus rhythm (including newer agents)? 7. What are the accuracy and utility of echocardiographic studies for predicting a) likelihood of benefitting from anticoagulation, b) successful conversion of AF and c) maintenance of sinus rhythm? 8. What are the benefits and harms of ACEIs, ARBs and statins in the prevention of new AF and progression of AF to heart failure? 9. What are the comparative benefits and harms of newer surgical and less invasive therapies, such as AVJ ablation, cardiac resynchronization therapy, left atrial appendage occlusive devices, and autonomic ganglion ablation or denervation?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

 

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

 

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

 

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

 

Describe any health-related risks, side effects, or harms that you are concerned about.

 

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

 

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Cardiovascular disease, including stroke and hypertension

AHRQ Priority Populations

None

Federal Health Care Program

None

Importance

Describe why this topic is important.

 

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

 

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

 

If yes, please explain:

 

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

The ACP, AAFP, and ACC plan to use this evidence report to develop a clinical practice guideline.

Describe the timeframe in which an answer to your question is needed.

 

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

 

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

The ACP, AAFP, and ACC plan to use this evidence report to develop a clinical practice guideline.

Are you making a suggestion as an individual or on behalf of an organization?

Organization

Please tell us how you heard about the Effective Health Care Program

Liaison Lore Joplin