Article type
Abstract
"Introduction
We undertook preparatory work to inform a proposed platform trial of multiple interventions to prevent atrial fibrillation after heart surgery – a serious concern for patients. Work included a survey with UK heart surgery centres, patient engagement, and a rapid systematic review and NMA to guide decision-making of an intervention prioritisation committee (IPC) of clinicians, patients and researchers. We describe the rapid and iterative execution of the NMA using an informal “Plan-Do-Study-Act” approach to adapt the NMA to meet decision-making needs.
Objectives
To conduct a rapid systematic review and NMA of interventions to prevent atrial fibrillation after heart surgery, iteratively adapted using a Plan-Do-Study-Act approach. PROSPERO protocol: CRD42023418967
Methods
We used as a starting point an existing large Cochrane Review (2013) of randomised controlled trials (RCTs). We updated the search to April 2023 (Medline, EMBASE and The Cochrane Library (CENTRAL)).
We imposed restrictions to conduct a rapid exploratory NMA, with two comparators placebo and ‘no treatment’: i) screened CENTRAL only; ii) only included published studies; iii) pragmatically limited interventions; iv) extracted a minimal dataset; v) no risk of bias assessment.
We conducted NMA in a frequentist framework, using CINeMA software and STATA NMA routines. We presented results graphically: forest plots for NMA results per comparison as risk ratios (Review Manager 5.4); and rank probability graphs. We performed GRADE assessments and reported numbers-needed-to-treat.
NMA and survey results were discussed at IPC meetings in a series of Plan-Do-Study-Act cycles, in which initial restrictions were relaxed iteratively and in stages based on decision-making need.
Results
We conducted five Plan-Do-Study-Act decision-making cycles (Table 1). The final network comprised 237 studies covering 43 interventions in almost 39,000 patients. The NMA identified 12 effective interventions. The IPC selected five for potential testing in the platform trial, based on effect estimate, strength of evidence, potential for adverse effects, acceptability of interventions to cardiac surgery centres, and IPC values and preferences.
Conclusions
NMA alongside GRADE certainty identified the most effective interventions. An iterative approach proved successful within the constraints of a rapid time frame.
Intervention prioritisation incorporated feasibility considerations and IPC values and preferences alongside the evidence. "
We undertook preparatory work to inform a proposed platform trial of multiple interventions to prevent atrial fibrillation after heart surgery – a serious concern for patients. Work included a survey with UK heart surgery centres, patient engagement, and a rapid systematic review and NMA to guide decision-making of an intervention prioritisation committee (IPC) of clinicians, patients and researchers. We describe the rapid and iterative execution of the NMA using an informal “Plan-Do-Study-Act” approach to adapt the NMA to meet decision-making needs.
Objectives
To conduct a rapid systematic review and NMA of interventions to prevent atrial fibrillation after heart surgery, iteratively adapted using a Plan-Do-Study-Act approach. PROSPERO protocol: CRD42023418967
Methods
We used as a starting point an existing large Cochrane Review (2013) of randomised controlled trials (RCTs). We updated the search to April 2023 (Medline, EMBASE and The Cochrane Library (CENTRAL)).
We imposed restrictions to conduct a rapid exploratory NMA, with two comparators placebo and ‘no treatment’: i) screened CENTRAL only; ii) only included published studies; iii) pragmatically limited interventions; iv) extracted a minimal dataset; v) no risk of bias assessment.
We conducted NMA in a frequentist framework, using CINeMA software and STATA NMA routines. We presented results graphically: forest plots for NMA results per comparison as risk ratios (Review Manager 5.4); and rank probability graphs. We performed GRADE assessments and reported numbers-needed-to-treat.
NMA and survey results were discussed at IPC meetings in a series of Plan-Do-Study-Act cycles, in which initial restrictions were relaxed iteratively and in stages based on decision-making need.
Results
We conducted five Plan-Do-Study-Act decision-making cycles (Table 1). The final network comprised 237 studies covering 43 interventions in almost 39,000 patients. The NMA identified 12 effective interventions. The IPC selected five for potential testing in the platform trial, based on effect estimate, strength of evidence, potential for adverse effects, acceptability of interventions to cardiac surgery centres, and IPC values and preferences.
Conclusions
NMA alongside GRADE certainty identified the most effective interventions. An iterative approach proved successful within the constraints of a rapid time frame.
Intervention prioritisation incorporated feasibility considerations and IPC values and preferences alongside the evidence. "