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

What is the comparative renal of differnt contrast media used in radiographic imaging ? What is the comparative efficacy of different therapies in preventing contrast induced nephropathy?

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:

Renal safety of different contrast media ( Iodixanol, Iopamidol, ioxaglate, iohexol etc) Relative efficacy of different preventive strategies ( normal saline versus sodium bicarbonate) for prophylaxis of CIN ( contrast induced nephropathy)

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.)

Patients undergoing coroanry angiography and interventions

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

Patients with renal dysfunction Patients with diabetes

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

Prevention of CIN and other renal complications associated with contrast media will reduce the procedural risk. Optimal choice of contrast media and preventive therapies will help guide physicians in choosing the agents that are safest for patients and hence reduce the long term delterious impact of contrast based procedures.

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

The renal complications from contrast media are one of the commonest procedural complications among the approximately 1 million patients who undergo this procedure in the US every year. Better knowledge of ideal therapeutic choices would help reduce these complications and make the procedure safer for the patients.

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

• Low income groups
• Minority groups
• Women
• Elderly

Federal Health Care Program

• Medicaid
• Medicare

Importance

Describe why this topic is important.

There are small differences in the risk fo renal toxicity from different contrast media. However, given the large number of patients who undergo contrast based procedures every day, these small differences may translate into a considerable health care burden.

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.)

My director of the cathetrization laboratory asked my opinion on the contrast media that we should use in our cathetrization laboratory.

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:

There is considerable debate on the subject and most of the literatue is mixed. Clear data would help guide institutional policy and be of major interest to most radiologists and interventional cardiologists.

Potential Impact

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

It will guide choice of contrast media for the cathetrization laboratory both at our institution as well as hospitals nationwide.

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

6 months to 1 year

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

Applies to all patients

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)

It will guide choice of contrast media for the cathetrization laboratory both at our institution as well as hospitals nationwide.

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