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Landray MJ, Bax JJ, Alliot L, Buyse M, Cohen A, Collins R, Hindricks G, James SK, Lane S, Maggioni AP, Meeker-O'Connell A, Olsson G, Pocock SJ, Rawlins M, Sellors J, Shinagawa K, Sipido KR, Smeeth L, Stephens R, Stewart MW, Stough WG, Sweeney F, Van de Werf F, Woods K, Casadei B. Improving public health by improving clinical trial guidelines and their application. Eur Heart J 2017; 38:1632-1637. [PMID: 28329235 PMCID: PMC5837481 DOI: 10.1093/eurheartj/ehx086] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 12/16/2016] [Accepted: 02/10/2017] [Indexed: 11/12/2022] Open
Abstract
Evidence generated from randomized controlled trials forms the foundation of cardiovascular therapeutics and has led to the adoption of numerous drugs and devices that prolong survival and reduce morbidity, as well as the avoidance of interventions that have been shown to be ineffective or even unsafe. Many aspects of cardiovascular research have evolved considerably since the first randomized trials in cardiology were conducted. In order to be large enough to provide reliable evidence about effects on major outcomes, cardiovascular trials may now involve thousands of patients recruited from hundreds of clinical sites in many different countries. Costly infrastructure has developed to meet the increasingly complex organizational and operational requirements of these clinical trials. Concerns have been raised that this approach is unsustainable, inhibiting the reliable evaluation of new and existing treatments, to the detriment of patient care. These issues were considered by patients, regulators, funders, and trialists at a meeting of the European Society of Cardiology Cardiovascular Roundtable in October 2015. This paper summarizes the key insights and discussions from the workshop, highlights subsequent progress, and identifies next steps to produce meaningful change in the conduct of cardiovascular clinical research.
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Affiliation(s)
- Martin J. Landray
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jeroen J. Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Marc Buyse
- IDDI and CluePoints, Louvain-la-Neuve, Belgium
- University of Hasselt, Hasselt, Belgium
| | - Adam Cohen
- Centre for Human Drug Research, Leiden, The Netherlands
| | - Rory Collins
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Stefan K. James
- Department of Medical Sciences, Cardiology, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | | | | | | | - Gunnar Olsson
- Board Member (advisory) of European Society of Cardiology, Sweden
| | - Stuart J. Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Michael Rawlins
- Medicines and Healthcare products Regulatory Agency, London, UK
| | | | | | - Karin R. Sipido
- Department of Cardiovascular Sciences, Experimental Cardiology, KU Leuven, University of Leuven, Leuven, Belgium
| | - Liam Smeeth
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Wendy Gattis Stough
- Campbell University College of Pharmacy and Health Sciences, North Carolina, USA
| | | | - Frans Van de Werf
- Department of Cardiovascular Sciences, University Hospitals, Leuven, Belgium
| | - Kerrie Woods
- National Institute for Health Research, National Health Service, London, UK
| | - Barbara Casadei
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Level 6, West Wing, Oxford, OX3 9DU, UK
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