Clinical Trial Details
— Status: Enrolling by invitation
Administrative data
NCT number |
NCT05116176 |
Other study ID # |
2021P000054 |
Secondary ID |
|
Status |
Enrolling by invitation |
Phase |
|
First received |
|
Last updated |
|
Start date |
December 15, 2021 |
Est. completion date |
March 2025 |
Study information
Verified date |
August 2023 |
Source |
Beth Israel Deaconess Medical Center |
Contact |
n/a |
Is FDA regulated |
No |
Health authority |
|
Study type |
Observational
|
Clinical Trial Summary
This is a prospective cohort study of older patients receiving implantable
cardioverter-defibrillators. The purpose of the TRACER-ICD study is to conduct a prospective
cohort investigation with the goal of 500 patients age >65 receiving new primary prevention
implantable cardioverter-defibrillators (ICDs). Patients will be followed quarterly for 18
months with interviews, electronic record review, and remote monitoring to characterize
clinical and functional trajectories following device implantation, with permission for
extended electronic follow-up for up to 10 years (Aim 1). This cohort will support validation
and refinement of an established model for predicting personalized outcome profiles for ICD
therapies and death (Aim 2). Lastly, we will combine electronic record review with
semi-structured interviews with patients and physicians to evaluate physician and patient
experiences with a prototype individualized shared decision-making (SDM) tool (Aim 3).
Description:
Study Objectives and Design
The specific aims, applicable methods, and main hypotheses of the TRACER-ICD study are as
follows:
Aim 1: To characterize the clinical course of patients aged >65 after ICD implantation by
establishing a multicenter prospective cohort (N=500). Baseline (verbal and in-person) and
quarterly (phone, electronic health records [EHR], remote monitoring) data collected up to 18
months or death will include: a. geriatric assessments (e.g. frailty, cognition,1 functional
status; b. comorbidities; c. quality of life and symptom burden; d. health services use; e.
SDM history; and f. ICD-recorded physical activity (minutes/day).
Factors associated with death and poor quality of life will be identified. Group-based
trajectory modeling will identify patient clusters with distinct trajectories of functional
status and quality of life following ICD implantation.
H1: A model integrating frailty and clinical factors will predict (a) death, (b) poor quality
of life, and (c) unfavorable functional trajectories after ICD implantation.
Aim 2: To validate a personalized prediction model of treatment outcomes of ICDs. We will
apply our established semi-competing risks approach5 to the prospective cohort, enriched by
the baseline geriatric assessments, to predict individual patients' probabilities of the
following outcome profiles at 6, 12, and 18 months post-implant: a. death without prior
shock, b. death with prior shock, c. survival without prior shock, and d. survival with prior
shock. The independent contribution of frailty, cognitive dysfunction, baseline quality of
life, and functional status (e.g. total deficits in ADL and IADL) to model performance will
be evaluated.
H2: Addition of frailty, cognitive dysfunction, quality of life, and functional status to a
model with cardiovascular variables will significantly improve model performance as assessed
by area under the curve (AUC).
Aim 3: To identify optimal strategies for incorporating personalized outcome profiles into
SDM. The main cohort's baseline interview and EHR review will provide quantitative data on
past SDM tools used by physicians. We will develop a prototype individualized version of the
Colorado SDM tool that incorporates 18-month outcome profiles using our semi-competing risk
model. We will perform semi-structured interviews of cardiologists (N=20) as well as patients
(N=20) recruited from the main cohort regarding process mapping of SDM from clinic to implant
procedure, including timing, content, format preferences, and impressions of the prototype
individualized tool.