CaRi-Heart for predicting cardiac risk in suspected coronary artery disease

4 Recommendations for further research

4.1 Further research is recommended to address the uncertainty around clinical outcomes for people with suspected coronary artery disease (CAD) who have had CaRi-Heart testing. The committee agreed that a linked evidence approach would be acceptable but that the studies identified by the external assessment group (EAG) were not enough to demonstrate the link between treating coronary inflammation and reducing cardiac events or death. It agreed that further studies were needed (see section 3.10). A clinical outcome study using CaRi-Heart to determine treatment strategy with people followed up for long enough to observe a reduction in cardiac events or death would be ideal. Data on subgroups defined by CT coronary angiography (CTCA; no CAD, non-obstructive CAD and obstructive CAD) would also be useful.

4.2 Further data on how CaRi-Heart affects clinical decision making and patient management compared with UK standard clinical practice (CTCA alongside clinical risk assessment) should be collected (see sections 3.8 and 3.9). QRISK3 should be included as a comparator for people who have no CAD identified on CTCA (see section 3.5).

4.3 External validation of CaRi-Heart in a UK setting would be useful (see section 3.6). Research should also include subgroups by sex, age, ethnicity, social deprivation, and CAD status if possible (see section 3.7).

4.4 Data should be collected on the costs associated with using CaRi-Heart, including implementation costs, training costs, and impact on costs and resource use later in the treatment pathway (see section 3.12).