Statistical analysis plan for the randomized controlled trial CardioCare MV investigating a novel integrated care concept (NICC) for patients suffering from chronic cardiovascular disease

Abstract

Background: Cardiovascular diseases are the major cause of death globally and represent a major economic burden on health care systems. For patients with heart failure, atrial fibrillation or therapy-resistant hypertension, we have developed a novel integrated care concept (NICC) which combines telemedicine with intensive support by a care center, including a call center, an integrated care network including inpatient and outpatient care providers and guideline therapy for patients (Schmidt et al. 2018 Trials 19:120). Here, we describe challenges and solutions in patient recruitment and provide the statistical analysis plan.

Methods: The study CardioCare MV is a prospective, randomized, controlled, parallel-group, open-label, bi-center trial with two groups for comparing NICC with standard of care (SoC). Because of issues with patient enrollment we adapted the study plan after consultation with the Ethics Committee and the funding agency. We altered the analysis strategy for the primary endpoints, which led to a change in the required sample size. We also changed the access points to patients from inpatient hospitals specialized in the treatment of patients with cardiovascular disease to specialized practices.

Results: Recruitment of patients started on 1 December 2017, and first patient in was on 4 December 2017. Recruitment was completed on 15 August 2019 as planned according to the amended study plan. The follow-up period will end in August 2020. A total of 964 patients was enrolled into the trial. The statistical analysis plan was finalized prior to last patient in. Results will be available by the end of 2020.

Discussion: The trial will inform care providers whether quality of care can be improved by an integrated care concept providing telemedicine through a round-the-clock call center approach. We expect that cost of the NICC will be lower than standard care because of reduced hospitalizations. The trial will guide additional research to disentangle the effects of this complex intervention.

Trial registration: DRKS, ID: DRKS00013124. Registered on 5 October 2017 ClinicalTrials.gov, ID: NCT03317951. Registered on 17 October 2017.

Keywords: Atrial fibrillation; Care center; Disease management program; Evidence-based care; Heart failure; Hospitalization; Integrated care; Randomized controlled trial; Telemedicine; Treatment-resistant hypertension.

Conflict of interest statement

Sissy Hintz and Drs. Miriam Mann, and Marcos Oliviera de Sousa are employees of Universitätsmedizin Rostock Versorgungsstrukturen GmbH, a subsidiary of Universitätsmedizin Rostock. Prof. Schmidt is board member of the Universitätsmedizin Rostock. Prof. Ziegler was CEO of StatSol and is CEO of Cardio-CARE AG. Dr. Katja Krockenberger is an employee of AMEDON GmbH. Bernard Brandewiede is CEO of AMEDON GmbH. All other authors declare no conflict of interest.