Clinical outcome endpoints in heart failure trials: a European Society of Cardiology Heart Failure Association consensus document
Abstract
Endpoint selection is a critically important step in clinical trial design. It poses major challenges for investigators, regulators, and study sponsors, and it also has important clinical and practical implications for physicians and patients. Clinical outcomes of interest in heart failure trials include all-cause mortality, cause-specific mortality, relevant non-fatal morbidity (e.g., all-cause and cause-specific hospitalization), composites capturing both morbidity and mortality, safety, symptoms, functional capacity, and patient-reported outcomes. Each of these endpoints has strengths and weaknesses that create controversies regarding which is most appropriate in terms of clinical importance, sensitivity, reliability, and consistency. Not surprisingly, a lack of consensus exists within the scientific community regarding the optimal endpoint(s) for both acute and chronic heart failure trials. In an effort to address these issues, the Heart Failure Association of the European Society of Cardiology (HFA-ESC) convened a group of expert heart failure clinical investigators, biostatisticians, regulators, and pharmaceutical industry scientists (Nice, France, 12-13 February 2012) to evaluate the challenges of defining heart failure endpoints in clinical trials and to develop a consensus framework. This report summarizes the group's recommendations for achieving common views on heart failure endpoints in clinical trials.
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Outstanding issues around existing patient-reported outcomes that may explain the relative lack of uptake include cost, copyright, practical implementation, lack of breadth of symptoms, challenges around presentation, issues around credibility of results, and the focus on survival for approval of new interventions.
“Outstanding issues around existing PROs that may explain the relative lack of uptake include cost, copyright, practical implementation, lack of breadth of symptoms, challenges around presentation, issues around credibility of results, and the focus on survival for approval of new interventions. 119”
From Prioritizing symptom management in the treatment of chronic heart failure (2020) · cites this paper as [119]
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- Authors
- Zannad, F., Garcia, A. A., Anker, S. D., Armstrong, P. W., Calvo, G., Cleland, J. G. F., Cohn, J. N., Dickstein, K., Domanski, M. J., Ekman, I., Filippatos, G. S., Gheorghiade, M., Hernandez, A. F., Jaarsma, T., Koglin, J., Konstam, M., Kupfer, S., Maggioni, A. P., Mebazaa, A., Metra, M., Nowack, C., Pieske, B., Piña, I. L., Pocock, S. J., Ponikowski, P., Rosano, G., Ruilope, L. M., Ruschitzka, F., Severin, T., Solomon, S., Stein, K., Stockbridge, N. L., Stough, W. G., Swedberg, K., Tavazzi, L., Voors, A. A., Wasserman, S. M., Woehrle, H., Zalewski, A., & McMurray, J. J. V.
- Affiliations
- Inserm (FR)
- European Medicines Agency (NL)
- Stiftung Charité (DE)
- University of Alberta (CA)
- Hospital Clínic de Barcelona (ES)
- Castle Hill Hospital (GB)
- University of Minnesota (US)
- Stavanger University Hospital (NO)
- Icahn School of Medicine at Mount Sinai (US)
- University of Gothenburg (SE)
- University General Hospital Attikon (GR)
- Northwestern University (US)
- Duke Medical Center (US)
- Linköping University (SE)
- Merck & Co., Inc., Rahway, NJ, USA (United States) (US)
- Tufts University (US)
- Takeda (United States) (US)
- Associazione Nazionale Medici Cardiologi Ospedalieri (IT)
- Hôpital Lariboisière (FR)
- University of Brescia (IT)
- Bayer (Germany) (DE)
- Medical University of Graz (AT)
- Montefiore Medical Center (US)
- London School of Hygiene & Tropical Medicine (GB)
- Wroclaw Medical University (PL)
- Istituti di Ricovero e Cura a Carattere Scientifico (IT)
- Research Institute Hospital 12 de Octubre (ES)
- University Hospital Zurich (CH)
- Novartis (Switzerland) (CH)
- Brigham and Women's Hospital (US)
- Boston Scientific Corporation , St. Paul, MN ,
- United States Food and Drug Administration (US)
- Campbell University (US)
- Sahlgrenska University Hospital (SE)
- Maria Cecilia Hospital (IT)
- University Medical Center Groningen (NL)
- Amgen (United States) (US)
- ResMed (Germany) (DE)
- Novartis Pharmaceuticals Corporation , East Hanover, NJ ,
- Western Infirmary (GB)
- Corresponding author
- Zannad, Faiez
- ORCID
- Zannad, Faiez
- Garcia, Angeles Alonso
- Anker, Stefan D.
- Armstrong, Paul W.
- Calvo, Gonzalo
- Cleland, John G.F.
- Cohn, Jay N.
- Dickstein, Kenneth
- Ekman, Inger
- Filippatos, Gerasimos S.
- Gheorghiade, Mihai
- Hernandez, Adrian F.
- Jaarsma, Tiny
- Koglin, Joerg
- Konstam, Marvin
- Kupfer, Stuart
- Maggioni, Aldo P.
- Mebazaa, Alexandre
- Metra, Marco
- Nowack, Christina
- Pieske, Burkert
- Piña, Ileana L.
- Pocock, Stuart J.
- Ponikowski, Piotr
- Rosano, Giuseppe
- Ruilope, Luis M.
- Ruschitzka, Frank
- Solomon, Scott
- Stockbridge, Norman L.
- Stough, Wendy Gattis
- Swedberg, Karl
- Tavazzi, Luigi
- Voors, Adriaan A.
- Wasserman, Scott M.
- Woehrle, Holger
- McMurray, John J.V.
- Venue
- European Journal of Heart Failure
- Publisher
- Oxford University Press (OUP)
- Published
- 2013-10-01
- Volume
- 15
- Issue
- 10
- Pages
- 1082-1094
- ISSN
- 1388-9842 (ISSN-L)
- 1879-0844
- OpenAlex
- W2072345235
- Cited by
- 231
- References
- 111
- Citations by year
- 2026: 10 · 2025: 16 · 2024: 12 · 2023: 17 · 2022: 20 · 2021: 21 · 2020: 17 · 2019: 13 · 2018: 20 · 2017: 23 · 2016: 25 · 2015: 18 · 2014: 17 · 2013: 1
- FWCI
- 13.83
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Heart Failure (publishedVersion)
- PubMed (publishedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion)
- Institutional Research Information System (Università degli Studi di Brescia) (submittedVersion)
- Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Funders
- National Institute for Health and Care Research (NF-SI-0611-10227)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Clinical Trials
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart rate and cardiovascular health
- Keywords
- heart failure, clinical trial endpoints, endpoint selection, all-cause mortality, hospitalization, composite endpoints, patient-reported outcomes, functional capacity, acute heart failure, chronic heart failure, consensus framework
- MeSH terms
- Clinical Trials as Topic, Heart Failure, Hospitalization, Humans, Recurrence, Outcome Assessment, Health Care
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