Improving Patient Reported Outcome Measures in Catheter Ablation

Study Overview
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Brief Summary
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This study will assess whether more frequent measurement of patient reported outcome measures (PROMs) - specifically health related quality of life (HRQL) - can improve the evaluation of the clinical effectiveness and cost-effectiveness of catheter ablation of ventricular tachycardia (VT) in patients with an Implantable Cardioverter Defibrillator (ICD). It is designed to have feasibility outcomes which contribute to answering the above.

Detailed Description
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Patients who have been implanted with an ICD are at risk of suffering from dangerous arrhythmias such as VT. Patients can experience clinical events including worsening of any underlying heart failure regardless of either VT ablation or medical therapy treatment strategy (anti-arrhythmic drugs (AAD)). VT ablation is a specialist procedure which has been proven in randomised clinical trials (RCTs) to confer symptomatic relief from VT, reduced hospitalisations and reduced shocks from ICDs. However, there is no effect on mortality. The frequent nature of clinical events in this group of patients may affect their health status quite dramatically and yet based on current trial evidence, only 3 out of 6 randomised trials in VT ablation reported PROMs. This can lead to brittle conclusions about the overall cost-effectiveness profile of a procedure such as VT ablation. This study will assess for the feasibility of more frequent HRQL monitoring and its impact on whether it is able to better capture the clinical narrative and quality of life changes of patients with severe heart failure and an ICD. And thus the assessment of both clinical effectiveness and cost effectiveness of catheter ablation of VT or continuing anti arrhythmic drug therapy. METHOD & SETTING Single centre study at St Bartholomew's Hospital London. Patients will be identified through established local pathways - there are traditional outpatient specialist clinics where Consultant Cardiologists receive referrals of patients for consideration of managing patients with VT, including ablation. In addition, there are joint VT clinics operated by Consultants as well as by cardiac physiologists. In the outpatient VT clinic, 85 patients were seen in a 10-month window - it is assumed that this scale will allow feasible identification of patients to be recruited to the both the groups of this study.

Official Title
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Use of Patient Reported Outcome Measures (PROMs) to Assess Quality of Life and Economic Evaluation of Cardiac Catheter Ablation of Ventricular Tachycardia: a Feasibility and Cohort Study

Conditions
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Ventricular Tachycardia, ICD, Quality of Life

Intervention / Treatment
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* Other: Validated quality of life questionnaire (EQ-5D & C-CAP)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adults (>18 years) With an Implantable Cardioverter Defibrillator (ICD) implanted >3 months from time of recruitment and a previous episode of documented VT requiring therapy from the ICD. And impaired LV/RV function Willing and able to give written informed consent Exclusion Criteria: Patients who are planning to move away from study site within 12 months of enrolment who wished to use postal method to complete their HRQL Patients who are unable to give informed consent

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention<br>Patients undergoing catheter ablation of VT | Other: Validated quality of life questionnaire (EQ-5D & C-CAP)<br>* Patient quality of life to be assessed at baseline, 1, 2, 3, 4, 6, 9 and 12 months<br>|
| Active Comparator: Comparator<br>Patients undergoing AAD therapy for VT | Other: Validated quality of life questionnaire (EQ-5D & C-CAP)<br>* Patient quality of life to be assessed at baseline, 1, 2, 3, 4, 6, 9 and 12 months<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Completion rate of HRQL forms for patients undergoing VT ablation and those starting or continuing AAD therapy |  | 1 year follow up | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Recruitment rate of patients who fulfil study criteria |  | 1 year | 
| - Patient preferences for either paper or electronic HQRL (as a percentage of total recruitment) |  | 1 year | 
| Patient reported HRQL of VT ablation and AAD therapy on both EQ-5D and C-CAP |  | 18 months | 
| Impact on the cost-effectiveness calculation of VT ablation (using EQ-5D, and a number of different EQ-5D data points) | Using the Incremental Cost-effectiveness ratio | 18 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Catheter ablation, Patient reported outcome measure, Incremental cost effectiveness ratio