Table 4Potential Future Research Needs based on the Comparative Effectiveness Review and stakeholder input

PICO ElementPotential Future Research Need
Population
  1. Does the comparative accuracy of NITs in women vary based on the pretest probability of CAD of the women undergoing the test? How does the pretest probability of CAD impact the findings on clinical decisionmaking?
  2. Does the comparative accuracy of NITs in women vary based on differing symptomology and timing at presentation?
  3. Does the comparative accuracy of NITs in women vary based on racial/ethnicity differences?
  4. Does the comparative accuracy of NITs in women vary based on patient risk profiles?
  5. Does the comparative accuracy of NITs in women vary based on different settings (outpatient, inpatient, emergency room)?*
  6. Does the comparative accuracy of NITs in women vary based on age?
  7. Does the comparative accuracy of NITs in women vary based on: body size, heart size, menopausal status, functional status, stress modality?
Intervention and comparator
8.

What is the comparative safety and accuracy of functional vs. anatomic NIT modalities?

9.

What is the comparative safety and accuracy of functional NIT testing strategies with and without imaging?

10.

Is there a sequential order in which NITs should be used for evaluating CAD (i.e., multiple testing or layered-testing strategies)?*

Outcome
11.

What are the potential harms of NITs?

12.

What is the impact of NIT modalities on outcomes beyond diagnostic accuracy (risk stratification, prognostic information, treatment decisions, and clinical outcomes)?

13.

What is the comparative effect of NIT modalities on utilization, further testing, and impact on cost?*

14.

Are women getting the same diagnostic testing as men? Are men over-tested and/or women under-tested?*

15.

What is the comparative accuracy in real world settings? (most of the studies were single center, best-quality/high expertise centers)

16.

How does patient preference of testing factor into decisionmaking?*

17.

What is the value of performing a specific NIT test for the diagnosis of CAD in women, compared with no testing?*

Implementation gaps
18.

Does clinician preference, availability, or setting (outpatient vs. chest pain unit of an emergency department) impact NIT use?*

19.

How would a better understanding of provider diagnostic ordering patterns and understanding of appropriate use guidelines to support evidence-based decisionmaking impact the use of NITs?*

CAD = coronary artery disease; NIT = noninvasive technology

*

Out-of-scope research topics are in italics.

Out-of-scope research topics are in italics.

From: Methods

Cover of Noninvasive Technologies for the Diagnosis of Coronary Artery Disease in Women: Future Research Needs
Noninvasive Technologies for the Diagnosis of Coronary Artery Disease in Women: Future Research Needs: Identification of Future Research Needs From Comparative Effectiveness Review No. 58 [Internet].
Future Research Needs Papers, No. 41.
Sanders GD, Patel MR, Chatterjee R, et al.

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