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Innovative Clinical Trial Designs for Precision Medicine in Heart Failure with Preserved Ejection Fraction

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Abstract

A major challenge in the care of patients with heart failure and preserved ejection fraction (HFpEF) is the lack of proven therapies due to disappointing results from randomized controlled trials (RCTs). The heterogeneity of the HFpEF syndrome and the use of conventional RCT designs are possible reasons underlying the failure of these trials. There are several factors—including the widespread adoption of electronic health records, decreasing costs of obtaining high-dimensional data, and the availability of a wide variety of potential therapeutics—that have evolved to enable more innovative clinical trial designs in HFpEF. Here, we review the current landscape of HFpEF RCTs and present several innovative RCT designs that could be implemented in HFpEF, including enrichment trials, adaptive trials, umbrella trials, basket trials, and machine learning-based trials (including examples for each). Our hope is that the description of the aforementioned innovative trial designs will stimulate new approaches to clinical trials in HFpEF.

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  1. T1 Center for Cardiovascular Therapeutics, Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Sanjiv J. Shah

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Correspondence to Sanjiv J. Shah.

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Funding

Dr. Shah is supported by the National Institutes of Health R01 HL107577 and R01 HL127028 and American Heart Association No. 16SFRN28780016 and No. 15CVGPSD27260148.

Conflict of Interest

Dr. Shah has received research grants from Actelion, AstraZeneca, Corvia, and Novartis and consulting fees from Actelion, Amgen, AstraZeneca, Bayer, Boehringer-Ingelheim, Cardiora, Eisai, Ironwood, Merck, Novartis, Sanofi, and United Therapeutics.

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This review article does not contain any primary data from studies with human participants or animals performed by the author.

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Editor Enrique Lara-Pezzi oversaw the review of this article

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Shah, S.J. Innovative Clinical Trial Designs for Precision Medicine in Heart Failure with Preserved Ejection Fraction. J. of Cardiovasc. Trans. Res. 10, 322–336 (2017). https://doi.org/10.1007/s12265-017-9759-8

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  • DOI: https://doi.org/10.1007/s12265-017-9759-8

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