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Geographic differences in heart failure trials
Author(s) -
Ferreira João Pedro,
Girerd Nicolas,
Rossignol Patrick,
Zannad Faiez
Publication year - 2015
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.326
Subject(s) - heart failure , medicine , ejection fraction , heart failure with preserved ejection fraction , clinical trial , randomized controlled trial , intensive care medicine , cardiology
Randomized controlled trials ( RCTs ) are essential to develop advances in heart failure ( HF ). The need for increasing numbers of patients (without substantial cost increase) and generalization of results led to the disappearance of international boundaries in large RCTs . The significant geographic differences in patients' characteristics, outcomes, and, most importantly, treatment effect observed in HF trials have recently been highlighted. Whether the observed regional discrepancies in HF trials are due to trial‐specific issues, patient heterogeneity, structural differences in countries, or a complex interaction between factors are the questions we propose to debate in this review. To do so, we will analyse and review data from HF trials conducted in different world regions, from heart failure with preserved ejection fraction ( HF‐PEF ), heart failure with reduced ejection fraction ( HF‐REF ), and acute heart failure ( AHF ). Finally, we will suggest objective and actionable measures in order to mitigate regional discrepancies in future trials, particularly in HF‐PEF where prognostic modifying treatments are urgently needed and in which trials are more prone to selection bias, due to a larger patient heterogeneity.

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