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Psotka MA, Ammon SE, Fiuzat M, Bozkurt B, Chung ES, Cole RT, Greene SJ, Kraus D, Ky B, McIlvennan CK, Shah P, Teerlink JR, Walsh MN, Jessup M, O'Connor CM. Heart Failure Site-Based Research in the United States: Results of the Heart Failure Society of America Research Network Survey. JACC Heart Fail 2019; 7:431-438. [PMID: 30981742 DOI: 10.1016/j.jchf.2019.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 02/03/2019] [Accepted: 02/04/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVES This study sought to determine clinician and scientist involvement in heart failure (HF) clinical research and to describe the challenges of conducting clinical trials in the United States. BACKGROUND Improvements in the current capability, potential, and deficiencies of the HF clinical research infrastructure in the United States are needed in order to enhance efficiency and impact. METHODS The Heart Failure Society of America (HFSA) distributed an electronic survey regarding HF clinical trial activity for the purpose of understanding the barriers that exist to conducting high-quality HF clinical research. RESULTS Overall, 1,794 HFSA members were queried, and 434 members (24%) completed surveys, whereas a total of 7,589 individuals with interest in HF were queried, and 615 completed surveys. Of the respondents, 410 (67%) were actively engaged in HF research and 120 (20%) were interested in research. Most respondents, 270, were physicians (44%); 311 of the total (76% of the total and 80% of physicians) practiced in academic institutions; 333 respondents (81%) had served as principal investigators and 73 (18%) as site coordinators. Respondents active in clinical research usually participated in 1 to 5 trials and enrolled 1 to 20 patients annually. Institutional review board (IRB) approval typically required 3 months, and contract completion required 3 to 6 months per site. The greatest barriers to research were insufficient site budgets, delay in contracting, inability to find participants meeting trial entry criteria, and unavailability of qualified study coordinators. CONCLUSIONS Many U.S. clinical research sites are constrained by budgetary, staffing, and contractual issues. The HFSA Research Network seeks to unify interested sites and deconstruct barriers to permit high-value HF research.
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Affiliation(s)
- Mitchell A Psotka
- Advanced Heart Failure, Inova Heart and Vascular Institute, Falls Church, Virginia.
| | | | - Mona Fiuzat
- Duke Clinical Research Institute, Durham, North Carolina
| | - Biykem Bozkurt
- Division of Cardiology, Winters Center for Heart Failure Research, Baylor College of Medicine, Houston, Texas
| | - Eugene S Chung
- Center for Heart Failure Therapy and Transplantation, The Christ Hospital, Cincinnati, Ohio
| | - Robert T Cole
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | | | - David Kraus
- Stern Cardiovascular Foundation, Memphis, Tennessee
| | - Bonnie Ky
- Perelman School of Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Colleen K McIlvennan
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado; Colorado Cardiovascular Outcomes Research Consortium, Denver, Colorado; Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Palak Shah
- Advanced Heart Failure, Inova Heart and Vascular Institute, Falls Church, Virginia
| | - John R Teerlink
- School of Medicine, University of California-San Francisco, San Francisco, California; Section of Cardiology, San Francisco Veterans Affairs Medical Center, San Francisco, California
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Massie BM, Collins JF, Ammon SE, Armstrong PW, Cleland JG, Ezekowitz M, Jafri SM, Krol WF, O'Connor CM, Schulman KA, Teo K, Warren SR. Randomized Trial of Warfarin, Aspirin, and Clopidogrel in Patients With Chronic Heart Failure. Circulation 2009; 119:1616-24. [DOI: 10.1161/circulationaha.108.801753] [Citation(s) in RCA: 326] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background—
Chronic heart failure remains a major cause of mortality and morbidity. The role of antithrombotic therapy in patients with chronic heart failure has long been debated. The objective of this study was to determine the optimal antithrombotic agent for heart failure patients with reduced ejection fractions who are in sinus rhythm.
Methods and Results—
This prospective, randomized clinical trial of open-label warfarin (target international normalized ratio of 2.5 to 3.0) and double-blind treatment with either aspirin (162 mg once daily) or clopidogrel (75 mg once daily) had a 30-month enrollment period and a minimum of 12 months of treatment. We enrolled 1587 men and women ≥18 years of age with symptomatic heart failure for at least 3 months who were in sinus rhythm and had left ventricular ejection fraction of ≤35%. The primary outcome was the time to first occurrence of death, nonfatal myocardial infarction, or nonfatal stroke. For the primary composite end point, the hazard ratios were as follows: for warfarin versus aspirin, 0.98 (95% CI, 0.86 to 1.12;
P
=0.77); for clopidogrel versus aspirin, 1.08 (95% CI, 0.83 to 1.40;
P
=0.57); and for warfarin versus clopidogrel, 0.89 (95% CI, 0.68 to 1.16;
P
=0.39). Warfarin was associated with fewer nonfatal strokes than aspirin or clopidogrel. Hospitalization for worsening heart failure occurred in 116 (22.2%), 97 (18.5%), and 89 (16.5%) patients treated with aspirin, clopidogrel, and warfarin, respectively (
P
=0.02 for warfarin versus aspirin).
Conclusion—
The primary outcome measure and the mortality data do not support the primary hypotheses that warfarin is superior to aspirin and that clopidogrel is superior to aspirin.
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Affiliation(s)
- Barry M. Massie
- From the Department of Veterans Affairs, San Francisco, Calif (B.M.M., S.E.A.); Cooperative Studies Program Coordinating Center, Veterans Affairs Medical Center, Perry Point, Md (J.F.C., W.F.K.); University of Alberta, Edmonton, Alberta, Canada (P.W.A.); Castle Hill Hospital, East Yorkshire, UK (J.G.F.C.); Lankenau Institute for Medical Research, Wynnewood, Pa (M.E.); Henry Ford Hospital, Detroit, Mich (S.M.J.); Duke University Medical Center, Durham, NC (C.M.O., K.A.S.); McMaster University Medical
| | - Joseph F. Collins
- From the Department of Veterans Affairs, San Francisco, Calif (B.M.M., S.E.A.); Cooperative Studies Program Coordinating Center, Veterans Affairs Medical Center, Perry Point, Md (J.F.C., W.F.K.); University of Alberta, Edmonton, Alberta, Canada (P.W.A.); Castle Hill Hospital, East Yorkshire, UK (J.G.F.C.); Lankenau Institute for Medical Research, Wynnewood, Pa (M.E.); Henry Ford Hospital, Detroit, Mich (S.M.J.); Duke University Medical Center, Durham, NC (C.M.O., K.A.S.); McMaster University Medical
| | - Susan E. Ammon
- From the Department of Veterans Affairs, San Francisco, Calif (B.M.M., S.E.A.); Cooperative Studies Program Coordinating Center, Veterans Affairs Medical Center, Perry Point, Md (J.F.C., W.F.K.); University of Alberta, Edmonton, Alberta, Canada (P.W.A.); Castle Hill Hospital, East Yorkshire, UK (J.G.F.C.); Lankenau Institute for Medical Research, Wynnewood, Pa (M.E.); Henry Ford Hospital, Detroit, Mich (S.M.J.); Duke University Medical Center, Durham, NC (C.M.O., K.A.S.); McMaster University Medical
| | - Paul W. Armstrong
- From the Department of Veterans Affairs, San Francisco, Calif (B.M.M., S.E.A.); Cooperative Studies Program Coordinating Center, Veterans Affairs Medical Center, Perry Point, Md (J.F.C., W.F.K.); University of Alberta, Edmonton, Alberta, Canada (P.W.A.); Castle Hill Hospital, East Yorkshire, UK (J.G.F.C.); Lankenau Institute for Medical Research, Wynnewood, Pa (M.E.); Henry Ford Hospital, Detroit, Mich (S.M.J.); Duke University Medical Center, Durham, NC (C.M.O., K.A.S.); McMaster University Medical
| | - John G.F. Cleland
- From the Department of Veterans Affairs, San Francisco, Calif (B.M.M., S.E.A.); Cooperative Studies Program Coordinating Center, Veterans Affairs Medical Center, Perry Point, Md (J.F.C., W.F.K.); University of Alberta, Edmonton, Alberta, Canada (P.W.A.); Castle Hill Hospital, East Yorkshire, UK (J.G.F.C.); Lankenau Institute for Medical Research, Wynnewood, Pa (M.E.); Henry Ford Hospital, Detroit, Mich (S.M.J.); Duke University Medical Center, Durham, NC (C.M.O., K.A.S.); McMaster University Medical
| | - Michael Ezekowitz
- From the Department of Veterans Affairs, San Francisco, Calif (B.M.M., S.E.A.); Cooperative Studies Program Coordinating Center, Veterans Affairs Medical Center, Perry Point, Md (J.F.C., W.F.K.); University of Alberta, Edmonton, Alberta, Canada (P.W.A.); Castle Hill Hospital, East Yorkshire, UK (J.G.F.C.); Lankenau Institute for Medical Research, Wynnewood, Pa (M.E.); Henry Ford Hospital, Detroit, Mich (S.M.J.); Duke University Medical Center, Durham, NC (C.M.O., K.A.S.); McMaster University Medical
| | - Syed M. Jafri
- From the Department of Veterans Affairs, San Francisco, Calif (B.M.M., S.E.A.); Cooperative Studies Program Coordinating Center, Veterans Affairs Medical Center, Perry Point, Md (J.F.C., W.F.K.); University of Alberta, Edmonton, Alberta, Canada (P.W.A.); Castle Hill Hospital, East Yorkshire, UK (J.G.F.C.); Lankenau Institute for Medical Research, Wynnewood, Pa (M.E.); Henry Ford Hospital, Detroit, Mich (S.M.J.); Duke University Medical Center, Durham, NC (C.M.O., K.A.S.); McMaster University Medical
| | - William F. Krol
- From the Department of Veterans Affairs, San Francisco, Calif (B.M.M., S.E.A.); Cooperative Studies Program Coordinating Center, Veterans Affairs Medical Center, Perry Point, Md (J.F.C., W.F.K.); University of Alberta, Edmonton, Alberta, Canada (P.W.A.); Castle Hill Hospital, East Yorkshire, UK (J.G.F.C.); Lankenau Institute for Medical Research, Wynnewood, Pa (M.E.); Henry Ford Hospital, Detroit, Mich (S.M.J.); Duke University Medical Center, Durham, NC (C.M.O., K.A.S.); McMaster University Medical
| | - Christopher M. O'Connor
- From the Department of Veterans Affairs, San Francisco, Calif (B.M.M., S.E.A.); Cooperative Studies Program Coordinating Center, Veterans Affairs Medical Center, Perry Point, Md (J.F.C., W.F.K.); University of Alberta, Edmonton, Alberta, Canada (P.W.A.); Castle Hill Hospital, East Yorkshire, UK (J.G.F.C.); Lankenau Institute for Medical Research, Wynnewood, Pa (M.E.); Henry Ford Hospital, Detroit, Mich (S.M.J.); Duke University Medical Center, Durham, NC (C.M.O., K.A.S.); McMaster University Medical
| | - Kevin A. Schulman
- From the Department of Veterans Affairs, San Francisco, Calif (B.M.M., S.E.A.); Cooperative Studies Program Coordinating Center, Veterans Affairs Medical Center, Perry Point, Md (J.F.C., W.F.K.); University of Alberta, Edmonton, Alberta, Canada (P.W.A.); Castle Hill Hospital, East Yorkshire, UK (J.G.F.C.); Lankenau Institute for Medical Research, Wynnewood, Pa (M.E.); Henry Ford Hospital, Detroit, Mich (S.M.J.); Duke University Medical Center, Durham, NC (C.M.O., K.A.S.); McMaster University Medical
| | - Koon Teo
- From the Department of Veterans Affairs, San Francisco, Calif (B.M.M., S.E.A.); Cooperative Studies Program Coordinating Center, Veterans Affairs Medical Center, Perry Point, Md (J.F.C., W.F.K.); University of Alberta, Edmonton, Alberta, Canada (P.W.A.); Castle Hill Hospital, East Yorkshire, UK (J.G.F.C.); Lankenau Institute for Medical Research, Wynnewood, Pa (M.E.); Henry Ford Hospital, Detroit, Mich (S.M.J.); Duke University Medical Center, Durham, NC (C.M.O., K.A.S.); McMaster University Medical
| | - Stuart R. Warren
- From the Department of Veterans Affairs, San Francisco, Calif (B.M.M., S.E.A.); Cooperative Studies Program Coordinating Center, Veterans Affairs Medical Center, Perry Point, Md (J.F.C., W.F.K.); University of Alberta, Edmonton, Alberta, Canada (P.W.A.); Castle Hill Hospital, East Yorkshire, UK (J.G.F.C.); Lankenau Institute for Medical Research, Wynnewood, Pa (M.E.); Henry Ford Hospital, Detroit, Mich (S.M.J.); Duke University Medical Center, Durham, NC (C.M.O., K.A.S.); McMaster University Medical
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