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McAlister F, Ezekowitz J, Wiebe N, et al. Cardiac Resynchronization Therapy for Congestive Heart Failure. Rockville (MD): Agency for Healthcare Research and Quality (US); 2004 Nov. (Evidence Reports/Technology Assessments, No. 106.)

  • This publication is provided for historical reference only and the information may be out of date.

This publication is provided for historical reference only and the information may be out of date.

Cover of Cardiac Resynchronization Therapy for Congestive Heart Failure

Cardiac Resynchronization Therapy for Congestive Heart Failure.

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Appendix B: Sample Data Forms

Sample Data Forms

Inclusion/Exclusion Criteria

  • Form B-1 Inclusion Form: CRT for CHF: Efficacy Review
  • Form B-2 Inclusion Form: CRT for CHF Safety Review

Quality Assessment

  • Form B-3 Assessment of methodology for randomized controlled trials (RCT): Efficacy review
  • Form B-4 Assessment of methodology for RCTs and non-RCTs: Safety Review

Data Extraction

  • Form B-5 Data extraction - CRT for CHF: Efficacy review
  • Form B-6 Data extraction - CRT for CHF: Safety review

Form B-1 Inclusion Form: CRT for CHF: Efficacy Review

Please assess each study according to the criteria below.

Image er-crdreinvf17.jpg

Form B-2 Inclusion Form: CRT for CHF Safety Review

Please assess each study according to the criteria below.

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Form B-3 Assessment of methodology for randomized controlled trials (RCT)

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Form B-4 Assessment of methodology for RCTs and non-RCTs: Safety Review

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Form B-5 Data extraction - CRT for CHF: Efficacy review

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Form B-6 Data extraction - CRT for CHF: Safety review

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