Translating clinical trials into clinical practice: a survey assessing the potential impact of the Pediatric Heart Network Infant Single Ventricle Trial.
BACKGROUND
A few studies have evaluated the impact of clinical trial results on practice in paediatric cardiology. The Infant Single Ventricle (ISV) Trial results published in 2010 did not support routine use of the angiotensin-converting enzyme inhibitor enalapril in infants with single-ventricle physiology. We sought to assess the influence of these findings on clinical practice.


METHODS
A web-based survey was distributed via e-mail to over 2000 paediatric cardiologists, intensivists, cardiothoracic surgeons, and cardiac advance practice nurses during three distribution periods. The results were analysed using McNemar's test for paired data and Fisher's exact test.


RESULTS
The response rate was 31.5% (69% cardiologists and 65% with >10 years of experience). Among respondents familiar with trial results, 74% reported current practice consistent with trial findings versus 48% before trial publication (p<0.001); 19% used angiotensin-converting enzyme inhibitor in this population "almost always" versus 36% in the past (p<0.001), and 72% reported a change in management or improved confidence in treatment decisions involving this therapy based on the trial results. Respondents familiar with trial results (78%) were marginally more likely to practise consistent with the trial results than those unfamiliar (74 versus 67%, p=0.16). Among all respondents, 28% reported less frequent use of angiotensin-converting enzyme inhibitor over the last 3 years.


CONCLUSIONS
Within 5 years of publication, the majority of respondents was familiar with the Infant Single Ventricle Trial results and reported less frequent use of angiotensin-converting enzyme inhibitor in single-ventricle infants; however, 28% reported not adjusting their clinical decisions based on the trial's findings.
1New England Research Institute,Watertown,Massachusetts.
Victor
http://orcid.org/0000-0002-2954-3194
V
Zak
2Children's Hospital at Montefiore/Albert Einstein College of Medicine,New York,New York.
Daphne T
DT
Hsu
3National Heart, Lung, and Blood Institute, National Institutes of Health,Bethesda,Maryland.
Victoria L
VL
Pemberton
4Boston Children's Hospital,Boston,Massachusetts.
Jami C
JC
Levine
5Medical University of South Carolina,Charleston,South Carolina.
Andrew M
AM
Atz
6Cincinnati Children's Hospital,Cincinnati,Ohio.
James F
JF
Cnota
7The Children's Hospital of Philadelphia,Philadelphia.
Chitra
C
Ravishankar
8Duke University Medical Center,Durham,North Carolina.
Piers
P
Barker
9Primary Children's Medical Center, University of Utah,Salt Lake City,Utah,United States of America.
Linda M
LM
Lambert
10The Hospital for Sick Children, University of Toronto,Toronto,Canada.
Brian W
BW
McCrindle
11Medical College of Wisconsin,Milwaukee,Wisconsin.
Michele A
MA
Frommelt
12Columbia University Medical Center,New York, New York,United States of America.
Karen
K
Altmann
1New England Research Institute,Watertown,Massachusetts.
Shan
S
Chen
9Primary Children's Medical Center, University of Utah,Salt Lake City,Utah,United States of America.
Richard V
RV
Williams
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000072096:Cardiologists; D002986:Clinical Trials as Topic; D034742:Electronic Mail; D004656:Enalapril / Q000627:therapeutic use*; D006330:Heart Defects, Congenital / Q000188:drug therapy* / Q000503:physiopathology; D006333:Heart Failure / Q000453:epidemiology; D006352:Heart Ventricles / Q000002:abnormalities*; D006801:Humans; D010372:Pediatrics; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D057170:Translational Research, Biomedical; D014481:United States
D000806:Angiotensin-Converting Enzyme Inhibitors; D004656:Enalapril
Single-ventricle physiology; angiotensin-converting enzyme inhibitor; physician survey