Improving representativeness in trials: a call to action from the Global Cardiovascular Clinical Trialists Forum.

Journal: European heart journal

Volume: 44

Issue: 11

Year of Publication: 2023

Affiliated Institutions:  Department of Medicine, McMaster University, Copeland Avenue, David Braley Research Building, Suite C-, Hamilton, ON LL A, Canada. Research Institute of St. Josephs, St. Joseph's Healthcare Hamilton, Charlton Ave E, Hamilton, ON LN A, Canada. Division of Cardiology, Duke Clinical Research Institute, W Morgan Street, Duke University School of Medicine, Durham, NC , USA. Cardiovascular Division, Stanford University School of Medicine, Campus Drive, Li Ka Shing Building, Stanford, CA -, USA. Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Center Drive, Building , Bethesda, MD , USA. CRONICAS Center of Excellence in Chronic Diseases, Av. Armendariz, nd floor, Miraflores , Lima, Peru. South African Medical Research Council and Division of Paediatric Cardiology, University of Cape Town and Red Cross Memorial Children's Hospital, Klipfontein Road, Rondebosch, Cape Town, Western Cape , South Africa. Department of Medicine, University of Mississippi Medical Center, North State Street, Jackson, MS , USA. Centre d'Investigations Cliniques Plurithématique , Université de Lorraine, rue du Morvan, ILM, ground floor, Vandoeuvre-des-Nancy, Meurthe-et-Moselle , France.

Abstract summary 

Participants enrolled in cardiovascular disease (CVD) randomized controlled trials are not often representative of the population living with the disease. Older adults, children, women, Black, Indigenous and People of Color, and people living in low- and middle-income countries are typically under-enrolled in trials relative to disease distribution. Treatment effect estimates of CVD therapies have been largely derived from trial evidence generated in White men without complex comorbidities, limiting the generalizability of evidence. This review highlights barriers and facilitators of trial enrollment, temporal trends, and the rationale for representativeness. It proposes strategies to increase representativeness in CVD trials, including trial designs that minimize the research burden on participants, inclusive recruitment practices and eligibility criteria, diversification of clinical trial leadership, and research capacity-building in under-represented regions. Implementation of such strategies could generate better and more generalizable evidence to reduce knowledge gaps and position the cardiovascular trial enterprise as a vehicle to counter existing healthcare inequalities.

Authors & Co-authors:  Filbey Lynaea L Zhu Jie Wei JW D'Angelo Francesca F Thabane Lehana L Khan Muhammad Shahzeb MS Lewis Eldrin E Patel Manesh R MR Powell-Wiley Tiffany T Miranda J Jaime JJ Zuhlke Liesl L Butler Javed J Zannad Faiez F Van Spall Harriette G C HGC

Study Outcome 

Source Link: Visit source

Statistics
Citations :  Van Spall HGC, Toren A, Kiss A, Fowler RA. Eligibility criteria of randomized controlled trials published in high-impact general medical journals: a systematic sampling review. JAMA 2007;297:1233–1240. 10.1001/jama.297.11.1233
Authors :  13
Identifiers
Doi : 10.1093/eurheartj/ehac810
SSN : 1522-9645
Study Population
Men
Mesh Terms
Humans
Other Terms
Clinical trials;Equity;Health equity‌;Research equity;Trial eligibility‌;Trial representativeness;diversity;inclusion
Study Design
Randomized Control Trial,Cross Sectional Study
Study Approach
Country of Study
Publication Country
England