Feasibility, process, and outcomes of cardiovascular clinical trial data sharing: A reproduction analysis of the SMART-AF Trial

IMPORTANCE Data sharing is as an expanding initiative for enhancing trust in the clinical research enterprise. OBJECTIVE To evaluate the feasibility, process, and outcomes of a reproduction analysis of the THERMOCOOL SMARTTOUCH Catheter for the Treatment of Symptomatic Paroxysmal Atrial Fibrillation (SMART-AF) trial using shared clinical trial data. DESIGN, SETTING, AND PARTICIPANTS A reproduction analysis of the SMART-AF trialwas performed using the data sets, data dictionary, case report file, and statistical analysis plan from the original trial accessed through the Yale Open Data Access Project using the SAS Clinical Trials Data Transparency platform. SMART-AF was a multicenter, single-arm trial evaluating the effectiveness and safety of an irrigated, contact force-sensing catheter for ablation of drug refractory, symptomatic paroxysmal atrial fibrillation in 172 participants recruited from 21 sites between June 2011 and December 2011. Analysis of the data was conducted between December 2016 and April 2017. MAIN OUTCOMES AND MEASURES Effectiveness outcomes included freedom from atrial arrhythmias after ablation and proportion of participants without any arrhythmia recurrence over the 12 months of follow-up after a 3-month blanking period. Safety outcomes included major adverse device- or procedure-related events. RESULTS The SMART AF trial participants' mean age was 58.7 (10.8) years, and 72%were men. The time from initial proposal submission to final analysis was 11 months. Freedom from atrial arrhythmias at 12 months postprocedure was similar compared with the primary study report (74.0%; 95%CI, 66.0-82.0 vs 76.4%; 95%CI, 68.7-84.1). The reproduction analysis success rate was higher than the primary study report (65.8%; 95%CI 56.5-74.2 vs 75.6%; 95%CI, 67.2-82.5). Adverse events were minimal and similar between the 2 analyses, but contact force range or regression models could not be reproduced. CONCLUSIONS AND RELEVANCE The feasibility of a reproduction analysis of the SMART-AF trial was demonstrated through an academic data-sharing platform. Data sharing can be facilitated through incentivizing collaboration, sharing statistical code, and creating more decentralized data sharing platforms with fewer restrictions to data access.