A Research Agenda to Improve Outcomes in Patients with Chronic Obstructive Pulmonary Disease and Cardiovascular Disease: An Official American Thoracic Society Research Statement
Laura C. Myers, Jennifer K Quint, Nathaniel M. Hawkins, Nirupama Putcha, Alan Hamilton, Peter K. Lindenauer, J. Michael Wells, Leah J. Witt, Sagar P. Shah, Todd A. Lee, Huong Q. Nguyen, Caroline Gainer, Allan J. Walkey, David M. Mannino, Surya P. Bhatt, R. Graham Barr, Richard A. Mularski, Mark T. Dransfield, Sadiya S. Khan, Andrea S. Gershon, Miguel Divo, Valerie G. Press
Abstract
Abstract Rationale Individuals with chronic obstructive pulmonary disease (COPD) are often at risk for or have comorbid cardiovascular disease and are likely to die of cardiovascular-related causes. Objectives To prioritize a list of research topics related to the diagnosis and management of patients with COPD and comorbid cardiovascular diseases (heart failure, atherosclerotic vascular disease, and atrial fibrillation) by summarizing existing evidence and using consensus-based methods. Methods A literature search was performed. References were reviewed by committee co-chairs. An international, multidisciplinary committee, including a patient advocate, met virtually to review evidence and identify research topics. A modified Delphi approach was used to prioritize topics in real time on the basis of their potential for advancing the field. Measurements and Main Results Gaps spanned the translational science spectrum from basic science to implementation: 1) disease mechanisms; 2) epidemiology; 3) subphenotyping; 4) diagnosis and management; 5) clinical trials; 6) care delivery; 7) medication access, adherence, and side effects; 8) risk factor mitigation; 9) cardiac and pulmonary rehabilitation; and 10) health equity. Seventeen experts participated, and quorum was achieved for all votes (>80%). Of 17 topics, ≥70% agreement was achieved for 12 topics after two rounds of voting. The range of summative Likert scores was −15 to 25. The highest priority was “Conduct pragmatic clinical trials with patient-centered outcomes that collect both pulmonary and cardiac data elements.” Health equity was identified as an important topic that should be embedded within all research. Conclusions We propose a prioritized research agenda with the purpose of stimulating high-impact research that will hopefully improve outcomes among people with COPD and cardiovascular disease.