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Martina MR, Park C, Alastruey J, Bruno RM, Climie R, Dogan S, Tuna BG, Jerončić A, Manouchehri M, Panayiotou AG, Tamarri S, Terentes-Printzios D, Testa M, Triantafyllou A, Mayer CC, Bianchini E. Medical device regulation in vascular ageing assessment: a VascAgeNet survey exploring knowledge and perception. Expert Rev Med Devices 2024; 21:335-347. [PMID: 38557297 DOI: 10.1080/17434440.2024.2334931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 03/15/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Regulation has a key role for medical devices throughout their lifecycle aiming to guarantee effectiveness and safety for users. Requirements of Regulation (EU) 2017/745 (MDR) have an impact on novel and previously approved systems. Identification of key stakeholders' needs can support effective implementation of MDR improving the translation to clinical practice of vascular ageing assessment. The aim of this work is to explore knowledge and perception of medical device regulatory framework in vascular ageing field. RESEARCH DESIGN AND METHODS A survey was developed within VascAgeNet and distributed in the community by means of the EUSurvey platform. RESULTS Results were derived from 94 participants (27% clinicians, 62% researchers, 11% companies) and evidenced mostly a fair knowledge of MDR (despite self-judged as poor by 51%). Safety (83%), validation (56%), risk management (50%) were considered relevant and associated with the regulatory process. Structured support and regulatory procedures connected with medical devices in daily practice at the institutional level are lacking (only 33% report availability of a regulatory department). CONCLUSIONS Regulation was recognized relevant by the VascAgeNet community and specific support and training in medical device regulatory science was considered important. A direct link with the regulatory sector is not yet easily available.
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Affiliation(s)
| | - Chloe Park
- University College London (UCL), London, UK
| | - Jordi Alastruey
- Department of Biomedical Engineering, King's College London, London, UK
| | - Rosa Maria Bruno
- PARCC (Paris Cardiovascular Research Center, Inserm U970), Université Paris Cité, Inserm, Paris, France
| | - Rachel Climie
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Soner Dogan
- Department of Medical Biology, Yeditepe University, School of Medicine, Istanbul, Turkiye
| | - Bilge Guvenc Tuna
- Department of Biophysics, Yeditepe University, School of Medicine, Istanbul, Turkiye
| | - Ana Jerončić
- Department of Research in Biomedicine and Health & Laboratory of Vascular Aging and Cardiovascular Prevention, University of Split School of Medicine, Split, Croatia
| | | | - Andrie G Panayiotou
- Department of Rehabilitation Sciences, Cyprus University of Technology, Limassol, Cyprus
| | | | - Dimitrios Terentes-Printzios
- First Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration Hospital, Athens, Greece
| | | | - Areti Triantafyllou
- 3rd Clinic of Internal Medicine, Papageorgiou GH, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christopher C Mayer
- AIT Austrian Institute of Technology GmbH, Center for Health & Bioresources, Medical Signal Analysis, Vienna, Austria
| | - Elisabetta Bianchini
- Institute of Clinical Physiology - Italian National Research Council (CNR-IFC), Pisa, Italy
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2
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Windecker S, Gilard M, Achenbach S, Cribier A, Delgado V, Deych N, Drossart I, Eltchaninoff H, Fraser AG, Goncalves A, Hindricks G, Holborow R, Kappetein AP, Kilmartin J, Kurucova J, Lüscher TF, Mehran R, O'Connor DB, Perkins M, Samset E, von Bardeleben RS, Weidinger F. Device innovation in cardiovascular medicine: a report from the European Society of Cardiology Cardiovascular Round Table. Eur Heart J 2024; 45:1104-1115. [PMID: 38366821 DOI: 10.1093/eurheartj/ehae069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2024] Open
Abstract
Research performed in Europe has driven cardiovascular device innovation. This includes, but is not limited to, percutaneous coronary intervention, cardiac imaging, transcatheter heart valve implantation, and device therapy of cardiac arrhythmias and heart failure. An important part of future medical progress involves the evolution of medical technology and the ongoing development of artificial intelligence and machine learning. There is a need to foster an environment conducive to medical technology development and validation so that Europe can continue to play a major role in device innovation while providing high standards of safety. This paper summarizes viewpoints on the topic of device innovation in cardiovascular medicine at the European Society of Cardiology Cardiovascular Round Table, a strategic forum for high-level dialogue to discuss issues related to the future of cardiovascular health in Europe. Devices are developed and improved through an iterative process throughout their lifecycle. Early feasibility studies demonstrate proof of concept and help to optimize the design of a device. If successful, this should ideally be followed by randomized clinical trials comparing novel devices vs. accepted standards of care when available and the collection of post-market real-world evidence through registries. Unfortunately, standardized procedures for feasibility studies across various device categories have not yet been implemented in Europe. Cardiovascular imaging can be used to diagnose and characterize patients for interventions to improve procedural results and to monitor devices long term after implantation. Randomized clinical trials often use cardiac imaging-based inclusion criteria, while less frequently trials randomize patients to compare the diagnostic or prognostic value of different modalities. Applications using machine learning are increasingly important, but specific regulatory standards and pathways remain in development in both Europe and the USA. Standards are also needed for smart devices and digital technologies that support device-driven biomonitoring. Changes in device regulation introduced by the European Union aim to improve clinical evidence, transparency, and safety, but they may impact the speed of innovation, access, and availability. Device development programmes including dialogue on unmet needs and advice on study designs must be driven by a community of physicians, trialists, patients, regulators, payers, and industry to ensure that patients have access to innovative care.
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Affiliation(s)
- Stephan Windecker
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Martine Gilard
- Département de Cardiologie, Hospital La Cavale Blanche, La Cavale Blanche Hospital Boulevard Tanguy Prigent, 29200 Brest, France
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen-Nürnberg, Germany
| | - Alain Cribier
- Department of Cardiology, Inserm U1096, Univ Rouen Normandie, F-76000 Rouen, France
| | - Victoria Delgado
- Department of Cardiology, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Nataliya Deych
- Regulatory Affairs, Edwards Lifesciences, Nyon, Switzerland
| | | | - Hélène Eltchaninoff
- Department of Cardiology, University Hospital Charles Nicolle, Rouen, France
| | - Alan G Fraser
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Alexandra Goncalves
- Precision Diagnostics, Philips, Cambridge, MA, USA
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto Medical School, Porto, Portugal
| | - Gerhard Hindricks
- Department of Cardiology, German Heart Center Charite, Berlin, Germany
| | | | | | | | - Jana Kurucova
- Transcatheter Heart Valve Division, Edwards Lifesciences, Nyon, Switzerland
| | - Thomas F Lüscher
- Department of Cardiology, Royal Brompton and Harefield Hospitals and Imperial College and King's College, London, UK
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Roxana Mehran
- Icahn School of Medicine, Mount Sinai Hospital, New York, NY, USA
| | | | - Mark Perkins
- GE Healthcare Cardiology Solutions, Harrogate, UK
| | - Eigil Samset
- GE Healthcare Cardiology Solutions, Oslo, Norway
- Department of Informatics, University of Oslo, Oslo, Norway
| | | | - Franz Weidinger
- 2nd Medical Department with Cardiology and Intensive Care Medicine, Klinik Landstrasse, Vienna, Austria
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3
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Siontis GCM, Coles B, Häner JD, McGovern L, Bartkowiak J, Coughlan JJ, Spirito A, Galea R, Haeberlin A, Praz F, Tomii D, Melvin T, Frenk A, Byrne RA, Fraser AG, Windecker S. Quality and transparency of evidence for implantable cardiovascular medical devices assessed by the CORE-MD consortium. Eur Heart J 2024; 45:161-177. [PMID: 37638967 DOI: 10.1093/eurheartj/ehad567] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/15/2023] [Accepted: 08/21/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND AND AIMS The European Union Medical Device Regulation 2017/745 challenges key stakeholders to follow transparent and rigorous approaches to the clinical evaluation of medical devices. The purpose of this study is a systematic evaluation of published clinical evidence underlying selected high-risk cardiovascular medical devices before and after market access in the European Union (CE-marking) between 2000 and 2021. METHODS Pre-specified strategies were applied to identify published studies of prospective design evaluating 71 high-risk cardiovascular devices in seven different classes (bioresorbable coronary scaffolds, left atrial appendage occlusion devices, transcatheter aortic valve implantation systems, transcatheter mitral valve repair/replacement systems, surgical aortic and mitral heart valves, leadless pacemakers, subcutaneous implantable cardioverter-defibrillator). The search time span covered 20 years (2000-21). Details of study design, patient population, intervention(s), and primary outcome(s) were summarized and assessed with respect to timing of the corresponding CE-mark approval. RESULTS At least one prospective clinical trial was identified for 70% (50/71) of the pre-specified devices. Overall, 473 reports of 308 prospectively designed studies (enrolling 97 886 individuals) were deemed eligible, including 81% (251/308) prospective non-randomized clinical trials (66 186 individuals) and 19% (57/308) randomized clinical trials (31 700 individuals). Pre-registration of the study protocol was available in 49% (150/308) studies, and 16% (48/308) had a peer-reviewed publicly available protocol. Device-related adverse events were evaluated in 82% (253/308) of studies. An outcome adjudication process was reported in 39% (120/308) of the studies. Sample size was larger for randomized in comparison to non-randomized trials (median of 304 vs. 100 individuals, P < .001). No randomized clinical trial published before CE-mark approval for any of the devices was identified. Non-randomized clinical trials were predominantly published after the corresponding CE-mark approval of the device under evaluation (89%, 224/251). Sample sizes were smaller for studies published before (median of 31 individuals) than after (median of 135 individuals) CE-mark approval (P < .001). Clinical trials with larger sample sizes (>50 individuals) and those with longer recruitment periods were more likely to be published after CE-mark approval, and were more frequent during the period 2016-21. CONCLUSIONS The quantity and quality of publicly available data from prospective clinical investigations across selected categories of cardiovascular devices, before and after CE approval during the period 2000-21, were deemed insufficient. The majority of studies was non-randomized, with increased risk of bias, and performed in small populations without provision of power calculations, and none of the reviewed devices had randomized trial results published prior to CE-mark certification.
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Affiliation(s)
- George C M Siontis
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - Bernadette Coles
- Velindre University NHS Trust Library and Knowledge Service, Cardiff, UK
| | - Jonas D Häner
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - Laurna McGovern
- Department of Cardiology and Cardiovascular Research Institute (CVRI) Dublin, Mater Private Network, Dublin, Ireland
| | - Joanna Bartkowiak
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - J J Coughlan
- Department of Cardiology and Cardiovascular Research Institute (CVRI) Dublin, Mater Private Network, Dublin, Ireland
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Alessandro Spirito
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Roberto Galea
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - Daijiro Tomii
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - Tom Melvin
- School of Medicine, Trinity College Dublin, Ireland
| | - André Frenk
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - Robert A Byrne
- Department of Cardiology and Cardiovascular Research Institute (CVRI) Dublin, Mater Private Network, Dublin, Ireland
| | - Alan G Fraser
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
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4
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Szymański P, Redberg R. Quality and transparency of clinical evidence for high-risk cardiovascular medical devices: a long way to go. Eur Heart J 2024; 45:178-180. [PMID: 38036418 DOI: 10.1093/eurheartj/ehad786] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Affiliation(s)
- Piotr Szymański
- Center for Clinical Cardiology, National Institute of Medicine MSWiA, Wołoska 137, 02-507 Warsaw, Poland
- Center of Postgraduate Medical Education, Warsaw, Poland
| | - Rita Redberg
- UCSF Division of Cardiology, SanFrancisco, CA, USA
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Chan BCF. The Challenges in Conducting Economic Evaluations for Rehabilitation Technologies. Top Spinal Cord Inj Rehabil 2023; 29:44-52. [PMID: 38174139 PMCID: PMC10759881 DOI: 10.46292/sci23-00035s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Background Health technology assessment (HTA) is an important evidentiary component in the decision-making process for the adoption of new healthcare technologies to the healthcare system. Economic evidence is an important consideration in HTAs. Recent systematic reviews in rehabilitation have shown a limited number of economic evaluations and high levels of uncertainty in the results. It is unclear whether there are challenges related to the field of rehabilitation and the technologies used in rehabilitation that inhibit the development of economic evidence. Methods In this study, economic evaluations in rehabilitation were reviewed. This was followed by a summary of the latest evidence on the challenges of conducting HTA for medical devices and the relationship with rehabilitation technologies. Finally, several considerations are suggested to improve the HTA of technologies that target rehabilitation. A literature review of Google Scholar and PubMed was conducted to identify reviews in economic evaluations in rehabilitation. A recent review on the barriers to HTA of medical devices in general was also examined to identify similar concerns with rehabilitation technologies. Results The challenges identified include the lack of high-quality studies, the interaction between the technology and the user, the short product life cycle, and estimation of efficacy in technologies with multiple target populations. Conclusion Overall, many of the challenges in evaluating medical devices also apply to rehabilitation interventions. Further research and discussion on these issues are necessary to increase the clinical evidence for rehabilitation technologies, strengthen the development of HTAs, and facilitate the use of technologies to improve the health of individuals requiring rehabilitation.
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Affiliation(s)
- Brian Chun-Fai Chan
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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6
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Eckhardt H, Felgner S, Dreger M, Fuchs S, Ermann H, Rödiger H, Rombey T, Busse R, Henschke C, Panteli D. Utilization of innovative medical technologies in German inpatient care: does evidence matter? Health Res Policy Syst 2023; 21:100. [PMID: 37784100 PMCID: PMC10546629 DOI: 10.1186/s12961-023-01047-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 08/26/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND The reimbursement of new technologies in inpatient care is not always linked to a requirement for evidence-based evaluation of patient benefit. In Germany, every new technology approved for market was until recently eligible for reimbursement in inpatient care unless explicitly excluded. The aim of this work was (1) to investigate the type of evidence that was available at the time of introduction of 25 innovative technologies and how this evidence evolved over time, and (2) to explore the relationship between clinical evidence and utilization for these technologies in German inpatient care. METHODS This study combined different methods. A systematic search for evidence published between 2003 and 2017 was conducted in four bibliographic databases, clinical trial registries, resources for clinical guidelines, and health technology assessment-databases. Information was also collected on funding mechanisms and safety notices. Utilization was measured by hospital procedures captured in claims data. The body of evidence, funding and safety notices per technology were analyzed descriptively. The relationship between utilization and evidence was explored empirically using a multilevel regression analysis. RESULTS The number of included publications per technology ranges from two to 498. For all technologies, non-comparative studies form the bulk of the evidence. The number of randomized controlled clinical trials per technology ranges from zero to 19. Some technologies were utilized for several years without an adequate evidence base. A relationship between evidence and utilization could be shown for several but not all technologies. CONCLUSIONS This study reveals a mixed picture regarding the evidence available for new technologies, and the relationship between the development of evidence and the use of technologies over time. Although the influence of funding and safety notices requires further investigation, these results re-emphasize the need for strengthening market approval standards and HTA pathways as well as approaches such as coverage with evidence development.
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Affiliation(s)
- Helene Eckhardt
- Department of Health Care Management, Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany.
| | - Susanne Felgner
- Department of Health Care Management, Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany
- Berlin Centre for Health Economics Research (BerlinHECOR), Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany
| | - Marie Dreger
- Department of Health Care Management, Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany
- Berlin Centre for Health Economics Research (BerlinHECOR), Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany
| | - Sabine Fuchs
- Department of Health Care Management, Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany
| | - Hanna Ermann
- Department of Health Care Management, Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany
| | - Hendrikje Rödiger
- Department of Health Care Management, Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany
| | - Tanja Rombey
- Department of Health Care Management, Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany
| | - Reinhard Busse
- Department of Health Care Management, Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany
- Berlin Centre for Health Economics Research (BerlinHECOR), Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany
| | - Cornelia Henschke
- Department of Health Care Management, Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany
- Berlin Centre for Health Economics Research (BerlinHECOR), Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany
| | - Dimitra Panteli
- Department of Health Care Management, Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany
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7
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Moons P, Norekvål TM, Arbelo E, Borregaard B, Casadei B, Cosyns B, Cowie MR, Fitzsimons D, Fraser AG, Jaarsma T, Kirchhof P, Mauri J, Mindham R, Sanders J, Schiele F, Torbica A, Zwisler AD. Placing patient-reported outcomes at the centre of cardiovascular clinical practice: implications for quality of care and management. Eur Heart J 2023; 44:3405-3422. [PMID: 37606064 DOI: 10.1093/eurheartj/ehad514] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 05/01/2023] [Accepted: 07/25/2023] [Indexed: 08/23/2023] Open
Abstract
Patient-reported outcomes (PROs) provide important insights into patients' own perspectives about their health and medical condition, and there is evidence that their use can lead to improvements in the quality of care and to better-informed clinical decisions. Their application in cardiovascular populations has grown over the past decades. This statement describes what PROs are, and it provides an inventory of disease-specific and domain-specific PROs that have been developed for cardiovascular populations. International standards and quality indices have been published, which can guide the selection of PROs for clinical practice and in clinical trials and research; patients as well as experts in psychometrics should be involved in choosing which are most appropriate. Collaborations are needed to define criteria for using PROs to guide regulatory decisions, and the utility of PROs for comparing and monitoring the quality of care and for allocating resources should be evaluated. New sources for recording PROs include wearable digital health devices, medical registries, and electronic health record. Advice is given for the optimal use of PROs in shared clinical decision-making in cardiovascular medicine, and concerning future directions for their wider application.
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Affiliation(s)
- Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven - University of Leuven, Kapucijnenvoer 35 PB7001, 3000 Leuven, Belgium
- Institute of Health and Care Sciences, University of Gothenburg, Arvid Wallgrens backe 1, 413 46 Gothenburg, Sweden
- Department of Paediatrics and Child Health, University of Cape Town, Klipfontein Rd, Rondebosch, 7700 Cape Town, South Africa
| | - Tone M Norekvål
- Department of Heart Disease, Haukeland University Hospital, Haukelandsveien 22, 5009 Bergen, Norway
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Jonas Lies veg, 875021 Bergen, Norway
| | - Elena Arbelo
- Cardiology Department, Hospital Clínic, Universitat de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain
- Institut d'Investigació August Pi i Sunyer (IDIBAPS). Rosselló 149-153, 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0, 28029 Madrid, Spain
| | - Britt Borregaard
- Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19, 5000 Odense, Denmark
| | - Barbara Casadei
- Division of Cardiovascular Medicine, RDM, University of Oxford; Headley Way, Headington Oxford OX3 9DU, UK
- NIHR Biomedical Research Centre, Headley Way, Headington Oxford OX3 9DU, UK
| | - Bernard Cosyns
- Department of Cardiology, University Hospital Brussels, Laarbeeklaan 101, 1090 Jette, Belgium
| | - Martin R Cowie
- Royal Brompton Hospital & School of Cardiovascular Medicine, Faculty of Medicine & Lifesciences, King's College London, Sydney St, London SW3 6NP, UK
| | - Donna Fitzsimons
- School of Nursing & Midwifery, Queens University Belfast, 97 Lisburn Road, Belfast | BT9 7BL, Northern Ireland
| | - Alan G Fraser
- School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XW, UK
| | - Tiny Jaarsma
- Department of Medicine, Health and Caring Sciences, Linköping University, Campus Norrköping, 601 74 Norrköping, Sweden
- Nursing Science, Julius Center, University Medical Centre Utrecht, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, D-20246 Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Martinistrasse 52, D-20246 Hamburg, Germany
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston Birmingham B15 2TT, UK
| | - Josepa Mauri
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet, s/n, 08916 Badalona, Barcelona, Spain
| | - Richard Mindham
- European Society of Cardiology (ESC) Patient Forum, 2035 route des colles, CS 80179 Biot, 06903 Sophia Antipolis Cedex, France
| | - Julie Sanders
- St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
- William Harvey Research Institute, Charterhouse Square, Queen Mary University of London, London EC1M 6BQ, UK
| | - Francois Schiele
- Department of Cardiology, University Hospital Besancon, 3 Bd Alexandre Fleming, 25030 Besançon, France
| | - Aleksandra Torbica
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Via Sarfatti, 10 20136 Milan, Italy
| | - Ann Dorthe Zwisler
- Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense, Denmark
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Vestergade 17, 5800 Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Campusvej 55, DK-5230 Odense, Denmark
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8
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Svennberg E, Caiani EG, Bruining N, Desteghe L, Han JK, Narayan SM, Rademakers FE, Sanders P, Duncker D. The digital journey: 25 years of digital development in electrophysiology from an Europace perspective. Europace 2023; 25:euad176. [PMID: 37622574 PMCID: PMC10450797 DOI: 10.1093/europace/euad176] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/03/2023] [Indexed: 08/26/2023] Open
Abstract
AIMS Over the past 25 years there has been a substantial development in the field of digital electrophysiology (EP) and in parallel a substantial increase in publications on digital cardiology.In this celebratory paper, we provide an overview of the digital field by highlighting publications from the field focusing on the EP Europace journal. RESULTS In this journey across the past quarter of a century we follow the development of digital tools commonly used in the clinic spanning from the initiation of digital clinics through the early days of telemonitoring, to wearables, mobile applications, and the use of fully virtual clinics. We then provide a chronicle of the field of artificial intelligence, a regulatory perspective, and at the end of our journey provide a future outlook for digital EP. CONCLUSION Over the past 25 years Europace has published a substantial number of papers on digital EP, with a marked expansion in digital publications in recent years.
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Affiliation(s)
- Emma Svennberg
- Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden
| | - Enrico G Caiani
- Politecnico di Milano, Electronic, Information and Biomedical Engineering Department, Milan, Italy
- Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Nico Bruining
- Department of Clinical and Experimental Information processing (Digital Cardiology), Erasmus Medical Center, Thoraxcenter, Rotterdam, The Netherlands
| | - Lien Desteghe
- Research Group Cardiovascular Diseases, University of Antwerp, 2000 Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital, 2056 Edegem, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, 3500 Hasselt, Belgium
- Department of Cardiology, Heart Centre Hasselt, Jessa Hospital, 3500 Hasselt, Belgium
| | - Janet K Han
- Division of Cardiology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
- Cardiac Arrhythmia Center, University of California Los Angeles, Los Angeles, CA, USA
| | - Sanjiv M Narayan
- Cardiology Division, Cardiovascular Institute and Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA, USA
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, 5005 Adelaide, Australia
| | - David Duncker
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
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Klar E, Leuchter M, Schliephake H, Markewitz A. Die Medical Device Regulation nach Geltungsbeginn: Wie können Gestaltungsspielräume zur Praktikabilität genutzt werden? Zentralbl Chir 2023; 148:187-191. [PMID: 37267972 DOI: 10.1055/a-2079-4967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Ernst Klar
- Chirurgische Klinik und Poliklinik, Universitätsmedizin Rostock, Rostock
| | - Matthias Leuchter
- Institut für ImplantatTechnologie und Biomaterialien, Universität Rostock, Rostock, Deutschland
| | - Henning Schliephake
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Andreas Markewitz
- Stellv. Vorsitzender, Ad-hoc-Kommission "Bewertung von Medizinprodukten", AWMF e.V., Berlin, Deutschland
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10
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Bretthauer M, Gerke S, Hassan C, Ahmad OF, Mori Y. The New European Medical Device Regulation: Balancing Innovation and Patient Safety. Ann Intern Med 2023. [PMID: 37068279 DOI: 10.7326/m23-0454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
The European Union has introduced stricter provisions for medical devices under the new Medical Device Regulation (MDR). The MDR increases requirements for clinical trial testing for many devices before they can legally be placed on the market and extends requirements for rigorous clinical surveillance of benefits and harms to the entire life cycle of devices. New "expert panels" have been established by the European Commission to advise in the assessment of devices toward certification, and the role of previous "notified bodies" (private companies charged by the Commission with ensuring that manufacturers follow the requirements for device testing) is being expanded. The MDR does not contain a grandfathering clause; thus, all existing medical devices must be recertified under the stricter regulation. The recertification deadline has recently been extended to 2027 or 2028, depending on the device's risk class. Whether most device manufacturers can meet these new requirements is uncertain, and the MDR will likely have important consequences for manufacturers, researchers, clinicians, and patients. Enhanced collaborations between the medical device industry and physician partners will be needed to meet the new requirements in a timely manner to avoid shortages of existing devices and to mitigate barriers to development of new devices.
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Affiliation(s)
- Michael Bretthauer
- Clinical Effectiveness Research Group, University of Oslo, and Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway, and Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway (M.B.)
| | - Sara Gerke
- Penn State Dickinson Law, Carlisle, Pennsylvania (S.G.)
| | - Cesare Hassan
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy, and Humanitas Clinical and Research Center-IRCCS, Endoscopy Unit, Rozzano, Italy (C.H.)
| | - Omer F Ahmad
- Wellcome/EPSRC Centre for Interventional & Surgical Sciences, University College London, London, United Kingdom (O.F.A.)
| | - Yuichi Mori
- Clinical Effectiveness Research Group, University of Oslo, and Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway, and Showa University Northern Yokohama Hospital, Digestive Disease Center, Yokohama, Japan (Y.M.)
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11
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Goetz G, Wernly B, Wild C. Wearable cardioverter defibrillator for preventing sudden cardiac death in patients at risk: An updated systematic review of comparative effectiveness and safety. IJC HEART & VASCULATURE 2023; 45:101189. [PMID: 37025482 PMCID: PMC10070821 DOI: 10.1016/j.ijcha.2023.101189] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/08/2023] [Accepted: 02/21/2023] [Indexed: 03/29/2023]
Abstract
Objectives To synthesise the available evidence of wearable cardioverter defibrillator (WCD) therapy as an add-on measure to optimal medical therapy (OMT) or as a replacement of hospital stay. Methods An update systematic review (SR) of comparative effectiveness and safety of WCD therapy was conducted. We included randomised controlled trials (RCT), prospective comparative studies and prospective uncontrolled studies with at least 100 patients. A narrative synthesis of the evidence was conducted. Results One RCT (n = 2348) and further eleven observational studies (n = 5345) fulfilled our inclusion criteria. In the only available RCT, the use of the WCD was not statistically associated with a clinical benefit on arrhythmic mortality in post-myocardial infarction (MI) patients with an ejection fraction of ≤35%. The compliance with WCD therapy was low in the RCT and high in observational studies, with ten observational studies reporting on a daily wear time between 20 and 23.5 h. The range of percentage of patients receiving at least one appropriate shock was 1-4.8% and the rate of first shock success was reported to be 100% in three studies. Serious adverse events (SAEs) such as inappropriate shocks occurred rarely, with between 0% and 2% of patients being inappropriately shocked within ten observational studies. In one of the observational studies, two patients (2%) were allergic to nickel developing skin rash and false alarms occurred in 58 patients (57%) in this study. Another registry study (n = 448) reported milder AEs, such as dermatitis and pressure marks, occurring in 0.9% and 0.2% of enrolled patients, respectively. Conclusion The only available RCT failed to show superiority of add-on use of WCD in post MI patients. Observational evidence shows that the compliance with WCD is good, but the evidence is afflicted with selection bias and the inclusion of diverse mixed patient populations diluting the ability to draw indication-specific conclusions on the utility of the device. More comparative data is needed to justify continuing or expanding use of WCD therapy.
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Affiliation(s)
- Gregor Goetz
- HTA Austria - Austrian Institute for Health Technology Assessment GmbH, Vienna, Austria
- Department of Health Care Management, Technical University Berlin, Germany
| | - Bernhard Wernly
- Institute of general practice, family medicine and preventive medicine, Strubergasse 21, 5020 Paracelsus Medical University, Salzburg, Austria
- Department of Internal Medicine, Teaching Hospital of the Paracelsus Medical University Salzburg, General Hospital Oberndorf, Paracelsus Medical University Salzburg, Oberndorf, Austria
| | - Claudia Wild
- HTA Austria - Austrian Institute for Health Technology Assessment GmbH, Vienna, Austria
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12
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Ren Y, Bertoldi M, Fraser AG, Caiani EG. Validation of CORE-MD PMS Support Tool: A Novel Strategy for Aggregating Information from Notices of Failures to Support Medical Devices' Post-Market Surveillance. Ther Innov Regul Sci 2023; 57:589-602. [PMID: 36652105 PMCID: PMC10133046 DOI: 10.1007/s43441-022-00493-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 12/24/2022] [Indexed: 01/19/2023]
Abstract
INTRODUCTION The EU Medical Device Regulation 2017/745 defines new rules for the certification and post-market surveillance of medical devices (MD), including an additional review by Expert Panels of clinical evaluation data for high-risk MD if reports and alerts suggest possibly associated increased risks. Within the EU-funded CORE-MD project, our aim was to develop a tool to support such process in which web-accessible safety notices (SN) are automatically retrieved and aggregated based on their specific MD categories and the European Medical Device Nomenclature (EMDN) classification by applying an Entity Resolution (ER) approach to enrich data integrating different sources. The performance of such approach was tested through a pilot study on the Italian data. METHODS Information relevant to 7622 SN from 2009 to 2021 was retrieved from the Italian Ministry of Health website by Web scraping. For incomplete EMDN data (68%), the MD best match was searched within a list of about 1.5 M MD on the Italian market, using Natural Language Processing techniques and pairwise ER. The performance of this approach was tested on the 2440 SN (32%) already provided with the EMDN code as reference standard. RESULTS The implemented ER method was able to correctly assign the correct manufacturer to the MD in each SN in 99% of the cases. Moreover, the correct EMDN code at level 1 was assigned in 2382 SN (97.62%), at level 2 in 2366 SN (96.97%) and at level 3 in 2329 SN (95.45%). CONCLUSION The proposed approach was able to cope with the incompleteness of the publicly available data in the SN. In this way, grouping of SN relevant to a specific MD category/group/type could be used as possible sentinel for increased rates in reported serious incidents in high-risk MD.
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Affiliation(s)
- Yijun Ren
- Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano, Milan, Italy
| | - Michele Bertoldi
- Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano, Milan, Italy
| | - Alan G Fraser
- Department of Cardiology, University Hospital of Wales, Wales, CF14 4XW, UK
| | - Enrico Gianluca Caiani
- Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano, Milan, Italy.
- Istituto Auxologico Italiano IRCCS, Milan, Italy.
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13
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Expanding Quality by Design Principles to Support 3D Printed Medical Device Development Following the Renewed Regulatory Framework in Europe. Biomedicines 2022; 10:biomedicines10112947. [PMID: 36428514 PMCID: PMC9687721 DOI: 10.3390/biomedicines10112947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022] Open
Abstract
The vast scope of 3D printing has ignited the production of tailored medical device (MD) development and catalyzed a paradigm shift in the health-care industry, particularly following the COVID pandemic. This review aims to provide an update on the current progress and emerging opportunities for additive manufacturing following the introduction of the new medical device regulation (MDR) within the EU. The advent of early-phase implementation of the Quality by Design (QbD) quality management framework in MD development is a focal point. The application of a regulatory supported QbD concept will ensure successful MD development, as well as pointing out the current challenges of 3D bioprinting. Utilizing a QbD scientific and risk-management approach ensures the acceleration of MD development in a more targeted way by building in all stakeholders' expectations, namely those of the patients, the biomedical industry, and regulatory bodies.
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Garzotto F, Comoretto RI, Dorigo L, Gregori D, Zotti A, Gaudenzio M, Gerosa G, Bonin M. Preparing healthcare, academic institutions and notified bodies for their involvement in the innovation of medical devices under the new European regulation. Expert Rev Med Devices 2022; 19:613-621. [PMID: 36039712 DOI: 10.1080/17434440.2022.2118046] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Favouring innovation by making timely medical technology available to people and by securing patients' safety is a challenge. AREAS COVERED The new European medical device regulation (MDR) will have a central implication in the development of new devices and could affect their innovation and availability, as well as discourage investment in research within Europe. EXPERT OPINION Start-ups and small companies might not be able to cope with the increasing complexity and the required changes of perspective. Healthcare institutions are facing an increasing availability of complex technologies, while data on their clinical efficacy and cost-effectiveness are rarely provided. A partnership/collaboration between healthcare institutions, academia and private industries will enhance their own specific interests with the common goal of improving overall health and quality of life. The complexity of the subject combined with the variety of specialists and stakeholders involved requires the implementation, in hospital centres of clinical excellence, of units dedicated to the whole path of the medical device innovation. Stakeholders should quickly provide adequate measures to facilitate the complex medical device innovation path under the more stringent MDR aimed to increase safety and quality of care.
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Affiliation(s)
- Francesco Garzotto
- Department of Cardiac Thoracic Vascular Sciences and Public Health, Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy.,ASL VCO, Piedmont Region, Italy.,Azienda Zero, Healthcare - Veneto Region, Italy
| | - Rosanna Irene Comoretto
- Department of Cardiac Thoracic Vascular Sciences and Public Health, Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy.,Department of Public Health and Pediatrics, University of Turin, Italy
| | | | - Dario Gregori
- Department of Cardiac Thoracic Vascular Sciences and Public Health, Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy
| | - Alessandro Zotti
- Department of Animal Medicine, Production and Health, University of Padua, Legnaro, Italy
| | - Meneghesso Gaudenzio
- Department of Information Engineering, University of Padova, Padova, 35131 Italy
| | - Gino Gerosa
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public HealthUniversity of Padua , Padua, Italy
| | - Mauro Bonin
- Department of Health Instrumental Resources, Veneto Region, Italy
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15
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Badnjević A, Pokvić LG, Deumić A, Bećirović LS. Post-market surveillance of medical devices: A review. Technol Health Care 2022; 30:1315-1329. [PMID: 35964220 DOI: 10.3233/thc-220284] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Medical devices (MDs) represent the backbone of the modern healthcare system. Considering their importance in daily medical practice, the process of manufacturing, marketing and usage has to be regulated at all levels. Harmonized evidence-based conformity assessment of MDs during PMS relying on traceability of medical device measurements can contribute to higher reliability of MD performance and consequently to higher reliability of diagnosis and treatments. OBJECTIVE This paper discusses issues within MD post-market surveillance (PMS) mechanisms in order to set a path to harmonization of MD PMS. METHODS Medline (1980-2021), EBSCO (1991-2021), and PubMed (1980-2021) as well as national and international legislation and standard databases along with reference lists of eligible articles and guidelines of relevant regulatory authorities such as European Commission, Food and Drug Administration were searched for relevant information. Journal articles that contain information regarding PMS methodologies concerning stand-alone medical devices. National and international legislation, standards and guidelines concerning the topic. RESULTS The search strategy resulted in 2282 papers. Out of those only 24 articles satisfied the eligibility criteria and were finally included in the review. Papers were grouped per categories: medical device registry, medical device adverse event reporting, and medical device performance evaluation. In addition to journal articles, national and international legislation, standards, and guidelines were reviewed to assess the state of PMS in different regions of the world. CONCLUSION Although the regulatory framework prescribes PMS of medical devices, the process itself is not harmonized with international standards. Particularly, conformity assessment of MDs, as an important part of PMS, is not measured and managed in a traceable, evidence-based manner. The lack of harmonization within PMS results in an environment of increased adverse events involving MDs and overall mistrust in medical device diagnosis and treatment results.
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Affiliation(s)
- Almir Badnjević
- Faculty of Pharmacy.,Verlab, Research Institute for Biomedical Engineering, Medical Devices and Artificial Intelligence, Sarajevo, Bosnia and Herzegovina.,Faculty of Pharmacy
| | - Lejla Gurbeta Pokvić
- Verlab, Research Institute for Biomedical Engineering, Medical Devices and Artificial Intelligence, Sarajevo, Bosnia and Herzegovina.,International Federation on Medical and Biological Engineering (IFMBE), Sarajevo, Bosnia and Herzegovina.,European Alliance for Medical and Biological Engineering and Science (EAMBES), Sarajevo, Bosnia and Herzegovina.,, Sarajevo, Bosnia and Herzegovina.,Faculty of Pharmacy
| | - Amar Deumić
- , Sarajevo, Bosnia and Herzegovina.,Verlab, Medical Device Inspection Laboratory, Sarajevo, Bosnia and Herzegovina.,Faculty of Pharmacy
| | - Lemana Spahić Bećirović
- Verlab, Research Institute for Biomedical Engineering, Medical Devices and Artificial Intelligence, Sarajevo, Bosnia and Herzegovina.,, Sarajevo, Bosnia and Herzegovina.,Faculty of Pharmacy
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16
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Wellnhofer E. Real-World and Regulatory Perspectives of Artificial Intelligence in Cardiovascular Imaging. Front Cardiovasc Med 2022; 9:890809. [PMID: 35935648 PMCID: PMC9354141 DOI: 10.3389/fcvm.2022.890809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 06/13/2022] [Indexed: 12/02/2022] Open
Abstract
Recent progress in digital health data recording, advances in computing power, and methodological approaches that extract information from data as artificial intelligence are expected to have a disruptive impact on technology in medicine. One of the potential benefits is the ability to extract new and essential insights from the vast amount of data generated during health care delivery every day. Cardiovascular imaging is boosted by new intelligent automatic methods to manage, process, segment, and analyze petabytes of image data exceeding historical manual capacities. Algorithms that learn from data raise new challenges for regulatory bodies. Partially autonomous behavior and adaptive modifications and a lack of transparency in deriving evidence from complex data pose considerable problems. Controlling new technologies requires new controlling techniques and ongoing regulatory research. All stakeholders must participate in the quest to find a fair balance between innovation and regulation. The regulatory approach to artificial intelligence must be risk-based and resilient. A focus on unknown emerging risks demands continuous surveillance and clinical evaluation during the total product life cycle. Since learning algorithms are data-driven, high-quality data is fundamental for good machine learning practice. Mining, processing, validation, governance, and data control must account for bias, error, inappropriate use, drifts, and shifts, particularly in real-world data. Regulators worldwide are tackling twenty-first century challenges raised by “learning” medical devices. Ethical concerns and regulatory approaches are presented. The paper concludes with a discussion on the future of responsible artificial intelligence.
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17
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Frankenberger EA, Resnic FS, Ssemaganda H, Robbins S, Dunbar MR, Coplan P, Zhang S, Bruno C, Maltenfort M, Benedetti JB, Matheny ME, Ghogawala Z. Evaluation of intervertebral body implant performance using active surveillance of electronic health records. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2022; 4:e000125. [PMID: 35909993 PMCID: PMC9272102 DOI: 10.1136/bmjsit-2021-000125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 06/06/2022] [Indexed: 11/04/2022] Open
Abstract
Objectives To assess the feasibility of using electronic health record (EHR) derived clinical data within an active surveillance setting to evaluate the safety of a novel intervertebral body implant (IVBI) stabilization device. Design Retrospective, longitudinal observational cohort study comparing clinical outcomes for patients seen through 1 year following spinal fusion surgery. Setting Lahey Health network, which includes academic tertiary hospitals, outpatient clinics, and independent provider offices in the New England region of the USA. Participants All spine surgery patients aged 18 or older who underwent thoracic or lumbar spinal arthrodesis surgeries were included. Main outcome measures The clinical outcomes of patients treated with the CONCORDE Bullet (CB) interbody spine system (DePuy) between April 2015 and December 2018 were compared with those patients receiving alternative spine stabilization interbody device implants. The primary endpoint was reoperation rate at 1 year, with secondary endpoints including the requirement for blood transfusion during index hospitalization, 1 year rate of any cause hospitalization, 1 year rate of surgical site infection, and mortality at 1 year. Results Among the 606 patients undergoing thoracic or lumbar spinal fusion surgery during the study period, 136 received only the CB. In comparison with patients who did not receive the CB, no significant differences were found in the rate of reoperation at 1 year or the rates of secondary safety outcomes. Conclusions Data derived from the EHR can be successfully leveraged to assess the safety of IVBI devices, in this case demonstrating no significant differences in the rates of risk-adjusted safety endpoints between patients undergoing spinal surgery with the CB as compared with alternative spinal implants.
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Affiliation(s)
- Edward A Frankenberger
- Comparative Effectiveness Research Institute, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Frederic S Resnic
- Comparative Effectiveness Research Institute, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
- Department of Cardiovascular Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Henry Ssemaganda
- Comparative Effectiveness Research Institute, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Susan Robbins
- Comparative Effectiveness Research Institute, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Melissa R Dunbar
- Comparative Effectiveness Research Institute, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
- Department of Neurosurgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Paul Coplan
- Johnson & Johnson Medical Devices, New Brunswick, New Jersey, USA
| | - Shumin Zhang
- Johnson & Johnson Medical Devices, New Brunswick, New Jersey, USA
| | - Cortney Bruno
- University of Pennsylvania College of Medicine, Philadelphia, Pennsylvania, USA
| | - Mitchell Maltenfort
- University of Pennsylvania College of Medicine, Philadelphia, Pennsylvania, USA
| | - Jillian B Benedetti
- Department of Pediatrics, Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
| | | | - Zoher Ghogawala
- Comparative Effectiveness Research Institute, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
- Department of Neurosurgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
- Department of Neurosurgery, Tufts University School of Medicine, Boston, Massachusetts, USA
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18
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Bianchini E, Mayer CC. Medical Device Regulation: Should We Care About It? Artery Res 2022; 28:55-60. [PMID: 35378951 PMCID: PMC8968778 DOI: 10.1007/s44200-022-00014-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/14/2022] [Indexed: 10/27/2022] Open
Abstract
AbstractMedical devices are subject to strict regulatory and approval processes to enter the market and to be used by operators and patients. These are needed to guarantee the users’ safety. The different activities of these processes have important implications for all involved stakeholders and for the whole lifecycle of a medical device. The aim of this work is to provide an overview of some key aspects of the new EU Medical Device Regulation and to show why researchers, innovators and clinicians should care about it. Awareness of regulatory requirements can improve the innovation process and its efficiency in terms of both social and ethical impact, but this awareness needs to be raised in the upcoming months and years. One can shortly say “yes, one needs to take care” of the new EU Medical Device Regulation. First and foremost, it is crucial for the sake of the users’ safety, which is the regulation’s intrinsic goal. Second, it should not just be seen as an obstacle for new innovations in the medical domain, but as a chance as it can provide new opportunities.
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19
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Penso M, Solbiati S, Moccia S, Caiani EG. Decision Support Systems in HF based on Deep Learning Technologies. Curr Heart Fail Rep 2022; 19:38-51. [PMID: 35142985 PMCID: PMC9023383 DOI: 10.1007/s11897-022-00540-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 11/26/2022]
Abstract
Purpose of Review Application of deep learning (DL) is growing in the last years, especially in the healthcare domain. This review presents the current state of DL techniques applied to electronic health record structured data, physiological signals, and imaging modalities for the management of heart failure (HF), focusing in particular on diagnosis, prognosis, and re-hospitalization risk, to explore the level of maturity of DL in this field. Recent Findings DL allows a better integration of different data sources to distillate more accurate outcomes in HF patients, thus resulting in better performance when compared to conventional evaluation methods. While applications in image and signal processing for HF diagnosis have reached very high performance, the application of DL to electronic health records and its multisource data for prediction could still be improved, despite the already promising results. Summary Embracing the current big data era, DL can improve performance compared to conventional techniques and machine learning approaches. DL algorithms have potential to provide more efficient care and improve outcomes of HF patients, although further investigations are needed to overcome current limitations, including results generalizability and transparency and explicability of the evidences supporting the process.
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Affiliation(s)
- Marco Penso
- Department of Electronics, Information and Biomedical Engineering, Politecnico Di Milano, P.zza L. da Vinci 32, 20133, Milan, Italy
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Sarah Solbiati
- Department of Electronics, Information and Biomedical Engineering, Politecnico Di Milano, P.zza L. da Vinci 32, 20133, Milan, Italy
- Institute of Electronics, Information Engineering and Telecommunications (IEIIT), Italian National Research Council (CNR), Milan, Italy
| | - Sara Moccia
- The BioRobotics Institute, Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Enrico G Caiani
- Department of Electronics, Information and Biomedical Engineering, Politecnico Di Milano, P.zza L. da Vinci 32, 20133, Milan, Italy.
- Institute of Electronics, Information Engineering and Telecommunications (IEIIT), Italian National Research Council (CNR), Milan, Italy.
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20
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Fraser AG, Nelissen RGHH, Kjærsgaard-Andersen P, Szymański P, Melvin T, Piscoi P. Improved clinical investigation and evaluation of high-risk medical devices: the rationale and objectives of CORE-MD (Coordinating Research and Evidence for Medical Devices). EFORT Open Rev 2021; 6:839-849. [PMID: 34760284 PMCID: PMC8559562 DOI: 10.1302/2058-5241.6.210081] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
In the European Union (EU), the delivery of health services is a national responsibility but there are concerted actions between member states to protect public health. Approval of pharmaceutical products is the responsibility of the European Medicines Agency, while authorising the placing on the market of medical devices is decentralised to independent ‘conformity assessment’ organisations called notified bodies. The first legal basis for an EU system of evaluating medical devices and approving their market access was the Medical Device Directive, from the 1990s. Uncertainties about clinical evidence requirements, among other reasons, led to the EU Medical Device Regulation (2017/745) that has applied since May 2021. It provides general principles for clinical investigations but few methodological details – which challenges responsible authorities to set appropriate balances between regulation and innovation, pre- and post-market studies, and clinical trials and real-world evidence. Scientific experts should advise on methods and standards for assessing and approving new high-risk devices, and safety, efficacy, and transparency of evidence should be paramount. The European Commission recently awarded a Horizon 2020 grant to a consortium led by the European Society of Cardiology and the European Federation of National Associations of Orthopaedics and Traumatology, that will review methodologies of clinical investigations, advise on study designs, and develop recommendations for aggregating clinical data from registries and other real-world sources. The CORE–MD project (Coordinating Research and Evidence for Medical Devices) will run until March 2024. Here, we describe how it may contribute to the development of regulatory science in Europe. Cite this article: EFORT Open Rev 2021;6:839-849. DOI: 10.1302/2058-5241.6.210081
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Affiliation(s)
- Alan G Fraser
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands
| | | | - Piotr Szymański
- Centre of Postgraduate Medical Education, MSWiA Central Clinical Hospital, Warsaw, Poland
| | - Tom Melvin
- Healthcare Products Regulatory Authority, Earlsfort Terrace, Dublin 2, Ireland
| | - Paul Piscoi
- Health Technology Unit B6, Directorate General for Health (DG SANTE), European Commission, Brussels, Belgium
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21
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Jansen JA. The Need of Standardized Methods, Protocols, and Directives for the Testing of Tissue Engineered Products. Tissue Eng Part C Methods 2021; 27:493-494. [PMID: 34550787 DOI: 10.1089/ten.tec.2021.29025.jaj] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- John A Jansen
- Department of Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands
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22
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Wierda E, de Mol BAJM, van Veghel D, Ploem MC. New EU law on medical devices: will it truly protect patients from malfunctioning cardiac implantable electronic devices? EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 8:1-3. [PMID: 34498662 DOI: 10.1093/ehjqcco/qcab064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 08/25/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022]
Affiliation(s)
- E Wierda
- Department of Cardiology, Department of Cardiology, Amsterdam University Medical Center
| | - B A J M de Mol
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center
| | - D van Veghel
- Department of Cardiology and Cardiothoracic Surgery, Catharina Hospital Eindhoven
| | - M C Ploem
- Department of Ethics, Law and Medical Humanities, Health Law Section, Amsterdam University Medical Center
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23
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Cocchieri R, van de Wetering B, Stijnen M, Riezebos R, de Mol B. The Impact of Biomedical Engineering on the Development of Minimally Invasive Cardio-Thoracic Surgery. J Clin Med 2021; 10:jcm10173877. [PMID: 34501325 PMCID: PMC8432110 DOI: 10.3390/jcm10173877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 11/16/2022] Open
Abstract
(1) We describe the boundary conditions for minimally invasive cardiac surgery (MICS) with the aim to reduce procedure-related patient injury and discomfort. (2) The analysis of the MICS work process and its demand for improved tools and devices is followed by a description of the relevant sub-specialties of bio-medical engineering: electronics, biomechanics, and materials sciences. (3) Innovations can represent a desired adaptation of an existing work process or a radical redesign of procedure and devices such as in transcutaneous procedures. Focused interaction between engineers, industry, and surgeons is always mandatory (i.e., a therapeutic alliance for addressing 'unmet patient or professional needs'. (4) Novel techniques in MICS lean heavily on usability and safe and effective use in dedicated hands. Therefore, the use of training and simulation models should enable skills selection, a safe learning curve, and maintenance of proficiency. (5) The critical technical steps and cost-benefit trade-offs during the journey from invention to application will be explained. Business considerations such as time-to-market and returns on investment do shape the cost-benefit room for commercial use of technology. Proof of clinical safety and effectiveness by physicians remains important, but establishing the technical reliability of MICS tools and warranting appropriate surgical skills come first.
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Affiliation(s)
- Riccardo Cocchieri
- Heart Center, OLVG Hospital, 1091 AC Amsterdam, The Netherlands; (R.C.); (R.R.)
| | - Bertus van de Wetering
- Department of Biomedical Engineering, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands;
- LifeTec Group BV, 5611 ZS Eindhoven, The Netherlands
- Correspondence: (B.v.d.W.); (B.d.M.)
| | - Marco Stijnen
- Department of Biomedical Engineering, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands;
- LifeTec Group BV, 5611 ZS Eindhoven, The Netherlands
| | - Robert Riezebos
- Heart Center, OLVG Hospital, 1091 AC Amsterdam, The Netherlands; (R.C.); (R.R.)
| | - Bastian de Mol
- Department of Biomedical Engineering, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands;
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
- Correspondence: (B.v.d.W.); (B.d.M.)
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24
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Fraser AG, Nelissen RGHH, Kjærsgaard-Andersen P, Szymański P, Melvin T, Piscoi P. Improved clinical investigation and evaluation of high-risk medical devices: the rationale and objectives of CORE-MD (Coordinating Research and Evidence for Medical Devices). EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 8:249-258. [PMID: 34448829 PMCID: PMC9071523 DOI: 10.1093/ehjqcco/qcab059] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022]
Abstract
In the European Union (EU) the delivery of health services is a national responsibility but there are concerted actions between member states to protect public health. Approval of pharmaceutical products is the responsibility of the European Medicines Agency, while authorising the placing on the market of medical devices is decentralised to independent 'conformity asssessment' organisations called notified bodies. The first legal basis for an EU system of evaluating medical devices and approving their market access was the medical device directives, from the 1990s. Uncertainties about clinical evidence requirements, among other reasons, led to the EU Medical Device Regulation (2017/745) that has applied since May 2021. It provides general principles for clinical investigations but few methodological details ‒ which challenges responsible authorities to set appropriate balances between regulation and innovation, pre- and post-market studies, and clinical trials and real-world evidence. Scientific experts should advise on methods and standards for assessing and approving new high-risk devices, and safety, efficacy, and transparency of evidence should be paramount. The European Commission recently awarded a Horizon 2020 grant to a consortium led by the European Society of Cardiology and the European Federation of National Associations of Orthopaedics and Traumatology, that will review methodologies of clinical investigations, advise on study designs, and develop recommendations for aggregating clinical data from registries and other real-world sources. The CORE‒MD project (Coordination of Research and Evidence for Medical Devices) will run until March 2024; here we describe how it may contribute to the development of regulatory science in Europe.
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Affiliation(s)
- A G Fraser
- Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK
| | - R G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
| | - P Kjærsgaard-Andersen
- Department of Orthopaedics, Vejle Hospital, South Danish University, DK-7100 Vejle, Denmark
| | - P Szymański
- Centre of Postgraduate Medical Education, MSWiA Central Clinical Hospital, ul. Woloska 137, 02-507 Warsaw, Poland
| | - T Melvin
- Healthcare Products Regulatory Authority, Earlsfort Terrace, Dublin 2, Ireland
| | - P Piscoi
- Health Technology Unit B6, Directorate General for Health (DG SANTE), European Commission, Brussels, Belgium
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25
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Antich-Isern P, Caro-Barri J, Aparicio-Blanco J. The combination of medical devices and medicinal products revisited from the new European legal framework. Int J Pharm 2021; 607:120992. [PMID: 34390808 DOI: 10.1016/j.ijpharm.2021.120992] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/20/2021] [Accepted: 08/08/2021] [Indexed: 02/06/2023]
Abstract
Medical devices and medicinal products have many similarities in their nature, scope or specific medical purposes, and despite the differences in their principal means of action, they are often used in combination. Indeed, many medicinal products depend on medical devices for their administration, and it is increasingly common for medical devices to contain medicinal substances to support their action. Therefore, the combination of medicinal products and medical devices provides additional benefits for patients. However, their higher technical complexity requires a strengthening of their authorisation and certification requirements. In this regard, more comprehensive requirements and classification rules are introduced by a new European regulation on medical devices that fully applies from May 26th 2021. On account of their therapeutic significance, this review aims at gaining insight into the borderline between medical devices and medicinal products in this new 2021 regulatory framework. For the first time, any item containing a medical device and a medicinal product will have both parts evaluated. Through exemplification of both marketed and investigational devices incorporating medicinal substances and drug-device combinations, the new European requirements and their implications are thoroughly illustrated herein.
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Affiliation(s)
- Pau Antich-Isern
- Department of Pharmaceutics and Food Technology, Faculty of Pharmacy, Complutense University of Madrid, Madrid, Spain
| | - Julia Caro-Barri
- Notified Body 0318, Spanish Agency of Medicines and Medical Devices (AEMPS), Madrid, Spain
| | - Juan Aparicio-Blanco
- Department of Pharmaceutics and Food Technology, Faculty of Pharmacy, Complutense University of Madrid, Madrid, Spain; Institute of Industrial Pharmacy, Complutense University of Madrid, Madrid, Spain.
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26
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Mayer CC, Francesconi M, Grandi C, Mozos I, Tagliaferri S, Terentes-Printzios D, Testa M, Pucci G, Bianchini E. Regulatory Requirements For Medical Devices And Vascular Ageing: An Overview. Heart Lung Circ 2021; 30:1658-1666. [PMID: 34362673 DOI: 10.1016/j.hlc.2021.06.517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/28/2021] [Accepted: 06/01/2021] [Indexed: 11/30/2022]
Abstract
The development and use of medical devices are subject to regulations and approval activities to enter the market. These are mandatory for manufacturers and have important implications for all involved professionals. In fact, the innovation process, starting from a clinical need, includes the identification of a solution and its implementation, and requires taking into account crucial aspects according to regulatory requirements in each phase. These include exemplary validation or risk management. The aim of this work is to provide an overview of some key aspects of regulation and their implementation in medical devices for vascular ageing assessment. In particular, regulatory scenarios in Europe, Australia and the United States of America are described and examples of marketed medical devices for vascular ageing assessment are provided. Strong and active links among industry, research, clinical experts and governments adds value for the community, requiring the ability to communicate between different skills and backgrounds: this multidisciplinary and multi-partner collaboration can speed up the innovation process and can increase the system's efficiency related to both social and ethical impact.
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Affiliation(s)
- Christopher Clemens Mayer
- Center for Health and Bioresources, Biomedical Systems, AIT Austrian Institute of Technology GmbH, Vienna, Austria
| | - Martina Francesconi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Ioana Mozos
- Department of Functional Sciences - Pathophysiology, Center for Translational Research and Systems Medicine, "Victor Babeș" University of Medicine and Pharmacy, Timișoara, Romania
| | | | - Dimitrios Terentes-Printzios
- First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Giacomo Pucci
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy; Unit of Internal Medicine, Terni University Hospital, Terni, Italy
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27
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Martelli N, Eskenazy D, Narayanan K, Lafont A, Marijon E. New European Regulation for Medical Devices. Eur Heart J 2021; 42:960-961. [PMID: 33508128 DOI: 10.1093/eurheartj/ehaa924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Nicolas Martelli
- Pharmacy Department, Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 20, rue Leblanc, 75015 Paris, France.,Université Paris-Saclay GRADES, 92290 Châtenay-Malabry, France
| | | | - Kumar Narayanan
- Cardiology Department, Medicover Hospitals, Hyderabad, India.,Université de Paris, PARCC, INSERM, F-75015 Paris, France
| | - Antoine Lafont
- Université de Paris, PARCC, INSERM, F-75015 Paris, France.,Cardiology Department, Assistance Publique - Hôpitaux de Paris, European Georges Pompidou Hospital, 20 rue Leblanc, 75015 Paris, France
| | - Eloi Marijon
- Université de Paris, PARCC, INSERM, F-75015 Paris, France.,Cardiology Department, Assistance Publique - Hôpitaux de Paris, European Georges Pompidou Hospital, 20 rue Leblanc, 75015 Paris, France
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28
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Singhal A, Cowie MR. Digital Health: Implications for Heart Failure Management. Card Fail Rev 2021; 7:e08. [PMID: 34035953 PMCID: PMC8135017 DOI: 10.15420/cfr.2020.28] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/29/2020] [Indexed: 12/24/2022] Open
Abstract
Digital health encompasses the use of information and communications technology and the use of advanced computing sciences in healthcare. This review covers the application of digital health in heart failure patients, focusing on teleconsultation, remote monitoring and apps and wearables, looking at how these technologies can be used to support care and improve outcomes. Interest in and use of these technologies, particularly teleconsultation, have been accelerated by the coronavirus disease 2019 pandemic. Remote monitoring of heart failure patients, to identify those patients at high risk of hospitalisation and to support clinical stability, has been studied with mixed results. Remote monitoring of pulmonary artery pressure has a consistent effect on reducing hospitalisation rates for patients with moderately severe symptoms and multiparameter monitoring shows promise for the future. Wearable devices and apps are increasingly used by patients for health and lifestyle support. Some wearable technologies have shown promise in AF detection, and others may be useful in supporting self-care and guiding prognosis, but more evidence is required to guide their optimal use. Support for patients and clinicians wishing to use these technologies is important, along with consideration of data validity and privacy and appropriate recording of decision-making.
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Affiliation(s)
| | - Martin R Cowie
- Royal Brompton Hospital London, UK
- School of Cardiovascular Medicine & Sciences, Faculty of Life Sciences & Medicine, King's College London London, UK
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29
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Crea F. A fresh look at ischaemic heart disease: from artificial intelligence to reappraisal of old drugs. Eur Heart J 2020; 41:4367-4370. [PMID: 33349864 DOI: 10.1093/eurheartj/ehaa964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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30
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Kapelios CJ, Naci H, Vardas PE, Mossialos E. Study design, result posting and publication of late-stage cardiovascular trials. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2020; 8:277-288. [PMID: 33098422 DOI: 10.1093/ehjqcco/qcaa080] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/07/2020] [Accepted: 10/09/2020] [Indexed: 12/13/2022]
Abstract
AIMS Pre-registration of study protocols in accessible databases is required for publication of study results in high-impact medical journals. Nonetheless, data on characteristics of clinical trials registered in these databases and their outcome, in terms of result reporting and publication are limited. METHODS AND RESULTS We searched for interventional, late-phase cardiovascular disease (CVD) studies in adults registered in Clinicaltrials.gov. first posted after 1/1/2013 and completed up to 31/12/2018. Data on study design, result reporting and publication were collected, and potential associations with a pre-defined set of explanatory factors were examined.In total, 250 CVD trials were included in the analysis. Of these, 193 (77.2%) were randomized studies, 99 (39.6%) open label designs, and 126 (50.4%) had industry as main sponsor. 179 trials (71.6%) evaluated the effect of drugs and 27 (10.8%) evaluated devices. The most common primary outcomes were non-clinical endpoints (76.0%), with only 17% of studies evaluating clinical endpoints. Industry-funded trials focused on patent-protected drugs and devices more often than non-industry-funded trials (72.0% vs. 30.6%, P < 0.001 and 55.0% vs. 26.3%, P = 0.033, respectively). Sixty three studies (25.2%) had results posted on clinicaltrials.gov, and 116 (46.4%) had results published in the scientific literature. In multivariate analysis, industry sponsorship was statistically significantly associated with results posting (OR: 3.38; 95% CI: 1.56-7.30, P = 0.002) and publication (OR: 0.41; 95% CI: 0.23-0.75, P = 0.004). CONCLUSION Among late-stage cardiovascular trials only 1/4 had results posted on clinicaltrials.gov and <50% had results published. Industry sponsors were more likely to invest in research on patent-protected drugs and devices than were non-industry sponsors. Industry-sponsored studies were more likely to have their results posted, but less likely to have their results published in the scientific literature.
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Affiliation(s)
- Chris J Kapelios
- Laiko General Hospital, Athens, Greece.,Department of Health Policy, London School of Economics and Political Science, London, U.K
| | - Huseyin Naci
- Department of Health Policy, London School of Economics and Political Science, London, U.K
| | | | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Science, London, U.K
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