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

For ST segment elevation patients undergoing PCI -percutaneous coronary intervention, what is the best combination with regard to anticoagulation, device and approach to reduce mortality and length of stay?

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:

*Anticoagulation--Glycoprotein Inhibitors or DTIs or Heparin products *Device-Closure device or not *Approach-Radial or femoral

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.)

all STEMI patients over the age of 65.

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

I hypothesize that women do more poorly with some interventions than others.

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

Reduction in mortality; Reduction in bleeding; Reduction in Length of Stay (and thereby the opportunity to acquire infection).

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

Ischemic adverse events Bleeding adverse events Death Readmissions

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.?

yes

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

• Elderly

Federal Health Care Program

• Medicaid
• Medicare

Importance

Describe why this topic is important.

CV disease is the number one killer and PCI is in the top 5 surgeries/interventions. There are large disparities of care in this arena...especially as it relates to the use of anticoagulants, closure devices and radial access. The NCDR database shows that there are ways to mitigate risk and yet there have not been conclusive guidelines given. Bleeding risk stratification should be done as it is the number one non ischemic cause of death in this population.

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.)

I am working on a doctoral research project and am evaluating the efficacy of a policy action plan requiring bleeding risk stratification for all PCI and CABG patients.

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.)

yes

If yes, please explain:

Yes as the approaches vary widely. There is concrete data on some points and merely observational data in others. Even the ACC/AHA guidelines are circumspect.

Potential Impact

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

Decide whehter to pursue a policy action plan for my doctoral work.

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

3-4 months.

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

There is data that shows elderly and those of african american dissent do more poorly during PCI. This also holds true for females.

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)

Decide whehter to pursue a policy action plan for my doctoral work.

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

Individual

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

from an AHRQ employee