Harriette Van Spall

Patient-reported outcome measures (PROMs) assess symptom burden, functional status, and health-related quality of life, and are more reproducible than clinician-elicited measures, which can be limited by reporting variability.

Most CVD-related PROMs fall short of quality standards needed to guide clinical research and practice, a systemic review has found, led by PHRI Scientist Harriette Van Spall.

PROMs are important measures of treatment effect and can be used to inform the approval of cardiovascular drugs and devices by the Food and Drug Administration (FDA).

The review was just published in Annals of Internal Medicine.

She and other cardiovascular researchers from McMaster University and University of Calgary created a comprehensive evidence map of 50 health status PROMs from 83 studies. They identified 45 disease-specific and 5 generic PROMs.

The disease-specific PROMs had been testing in specific CVD conditions such as heart failure, ischemic heart disease, and arrhythmias.

The investigators report that 22 percent of the 50 PROMs validated in CVDs had minimally important differences (MIDs) established, and 16 percent reported on the validation of all psychometric properties – relevance and usefulness – recommended by the FDA.

By Consensus-based Standards for the selection of health Measurement Instruments (COSMIN), only 2 PROMs had all of their psychometric properties rated as sufficient in quality, and 64% of PROMs had fewer than half of psychometric properties rated as sufficient.

The authors found that no generic PROM, and only 1 in 6 disease-specific PROMs, fulfilled all the FDA requirements for product approval.

They also report that no generic PROMs and only 2 disease specific PROMs had all 9 COSMIN-defined properties classified as sufficient.

“Our work highlights the need for careful adherence to standardized methodological criteria for PROM development and validation, and clear reporting of the psychometric properties of existing instruments. Given the use of PROMs to guide FDA approvals of drugs and devices in CVDs, there is a need for better adherence to quality standards in PROM validation studies.”

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