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Zannad F, Pfeffer MA, Bhatt DL, Bonds DE, Borer JS, Calvo-Rojas G, Fiore L, Lund LH, Madigan D, Maggioni AP, Meyers CM, Rosenberg Y, Simon T, Stough WG, Zalewski A, Zariffa N, Temple R. Streamlining cardiovascular clinical trials to improve efficiency and generalisability. Heart 2017; 103:1156-1162. [PMID: 28455296 DOI: 10.1136/heartjnl-2017-311191] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 03/07/2017] [Accepted: 03/19/2017] [Indexed: 11/04/2022] Open
Abstract
Controlled trials provide the most valid determination of the efficacy and safety of an intervention, but large cardiovascular clinical trials have become extremely costly and complex, making it difficult to study many important clinical questions. A critical question, and the main objective of this review, is how trials might be simplified while maintaining randomisation to preserve scientific integrity and unbiased efficacy assessments. Experience with alternative approaches is accumulating, specifically with registry-based randomised controlled trials that make use of data already collected. This approach addresses bias concerns while still capitalising on the benefits and efficiencies of a registry. Several completed or ongoing trials illustrate the feasibility of using registry-based controlled trials to answer important questions relevant to daily clinical practice. Randomised trials within healthcare organisation databases may also represent streamlined solutions for some types of investigations, although data quality (endpoint assessment) is likely to be a greater concern in those settings. These approaches are not without challenges, and issues pertaining to informed consent, blinding, data quality and regulatory standards remain to be fully explored. Collaboration among stakeholders is necessary to achieve standards for data management and analysis, to validate large data sources for use in randomised trials, and to re-evaluate ethical standards to encourage research while also ensuring that patients are protected. The rapidly evolving efforts to streamline cardiovascular clinical trials have the potential to lead to major advances in promoting better care and outcomes for patients with cardiovascular disease.
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Affiliation(s)
- Faiez Zannad
- Clinical Investigation Center, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Marc A Pfeffer
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Deepak L Bhatt
- Brigham and Women's Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Denise E Bonds
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jeffrey S Borer
- The Howard Gilman Institute, New York, New York, USA.,State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Gonzalo Calvo-Rojas
- Department of Clinical Pharmacology, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Louis Fiore
- Department of Veterans Affairs, Cooperative Studies Program, Boston, Massachusetts, USA
| | - Lars H Lund
- Department of Medicine, Unit of Cardiology, Karolinska Institute, Stockholm, Sweden
| | - David Madigan
- Department of Statistics, Columbia University, New York, New York, USA
| | | | - Catherine M Meyers
- National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Yves Rosenberg
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Tabassome Simon
- Assistance Publique-Hôpitaux de Paris, Saint Antoine Hospital, Paris, France.,Université Pierre et Marie Curie, Paris, France
| | - Wendy Gattis Stough
- Campbell University College of Pharmacy and Health Sciences, Research Triangle Park, North Carolina, USA
| | | | | | - Robert Temple
- Center for Drug Evaluation and Research, United States Food and Drug Administration, Silver Spring, Maryland, USA
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