The Duke EPC used a three-step prioritization process to engage stakeholders in the evaluation of future research needs in the use of ACE inhibitors and ARBs in patients with IHD. The prioritization process combined qualitative surveys of stakeholders and quantitative analysis of research uncertainties. Through this cumulative process we determined that six research areas were consistently ranked highly and deemed most important. These research areas, and our recommended study designs for these future projects, are:

• Strategies to enhance greater evidence-based use of ACE inhibitors/ARBs
  • Recommended study design: Analysis of existing observational data (note that evidence from other clinical domains may be appropriate here, since there is no reason to suspect that the barriers to evidence-based use of ACE inhibitors/ARBs are unique to these drugs or specific patient populations)
  • Note that although ranked as top priority consistently by our stakeholder group, this research area is outside the scope of the original CER report.
• The impact of ACE inhibitor/ARB adherence (including differential adherence within and between medication classes) on their effectiveness or harms in patients with stable IHD
  • Recommended study design: New observational study
• Impact of comorbidities (such as hypertension, CHF with or without preserved LV function, diabetes, peripheral arterial disease, chronic kidney disease, prior coronary revascularization; single- vs. multi-vessel coronary artery disease) on ACE inhibitor/ARB effectiveness or harms in patients with stable IHD
  • Recommended study design: Meta-analysis of RCTs (patient-level analysis would be particularly useful)
• The impact of ACE inhibitor/ARB in patients with stable IHD on patient quality of life
  • Recommended study design: Incorporation of quality-of-life metrics into new RCT or observational studies
• Impact of demographic differences (such as age, race, sex) on ACE inhibitor/ARB effectiveness or harms in patients with stable IHD
  • Recommended study design: Analysis of existing observational data, or if patient-level data from existing RCTs are available, a meta-analysis of these data would allow exploration of heterogeneity in treatment effects
• The impact of ACE inhibitor/ARB in patients with stable IHD on incidence of new diagnoses (such as diabetes, atrial fibrillation, CHF with or without preserved LV function)
  • Recommended study design: Meta-analysis of RCTs (patient-level analysis would be particularly useful)
  • Note that although consistently highly ranked by our stakeholder group, this research area is outside the scope of the original CER report.