Northern Territory Perspectives on Heart Failure with Comorbidities – Understanding Trial Validity and Exploring Collaborative Opportunities to Broaden the Evidence Base

Iyngkaran, Pupalan; Majoni, William; Cass, Alan; Sanders, Prashanthan; Ronco, Claudio; Brady, Stephen; Kangaharan, Nadarajah; Ilton, Marcus; Hare, David; Thomas, Merlin C.

doi:10.1016/j.hlc.2014.12.007

Cited by 20 publications

(30 citation statements)

References 30 publications

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“…Phase 4 studies have indicated that acting on clinical trial‐derived evidence does not achieve the expected outcomes unless the findings have been validated at the community level . In organised programs with this aim, the art of medical practice becomes evident when assessing non‐phenotypic factors such as rapport, compliance, trust, satisfaction, behavioural change, and personal psychology.…”

Section: The Importance Of a Patient's Cultural Background For Medicamentioning

confidence: 99%

Health care in a globalised world: is there more than one type of patient?

Iyngkaran

Jelinek

2019

Medical Journal of Australia

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Section: The Importance Of a Patient's Cultural Background For Medicamentioning

confidence: 99%

Health care in a globalised world: is there more than one type of patient?

Iyngkaran

Jelinek

2019

Medical Journal of Australia

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“…Medication side effects, extra class interactions, and pill burden are poorly factored in RCT or guidelines. 5 , 6 Posttranslational research for evidence to simplify therapeutic regimes or to improve efficacy is also lacking. 5 , 6 …”

Section: Defining Key Areas To Studymentioning

confidence: 99%

“…Medication side effects, extra class interactions, and pill burden are poorly factored in RCT or guidelines. 5 , 6 …”

Section: Defining Key Areas To Studymentioning

confidence: 99%

“…Posttranslational research for evidence to simplify therapeutic regimes or to improve efficacy is also lacking. 5 , 6 …”

Section: Defining Key Areas To Studymentioning

confidence: 99%

“…first, a higher percentage of clients who would not qualify for RCT inclusion because of severity of illness of perhaps exclusions after the run-in period 5 ;…”

Section: Hf and Indigenous Populationsmentioning

confidence: 99%

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Bedside–to-Bench Translational Research for Chronic Heart Failure: Creating an Agenda for Clients who do Not Meet Trial Enrollment Criteria

Iyngkaran

Thomas

2015

Clin Med Insights Cardiol

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Congestive heart failure (CHF) is a chronic condition usually without cure. Significant developments, particularly those addressing pathophysiology, mainly started at the bench. This approach has seen many clinical observations initially explored at the bench, subsequently being trialed at the bedside, and eventually translated into clinical practice. This evidence, however, has several limitations, importantly the generalizability or external validity. We now acknowledge that clinical management of CHF is more complicated than merely translating bench-to-bedside evidence in a linear fashion. This review aims to help explore this evolving area from an Australian perspective. We describe the continuation of research once core evidence is established and describe how clinician–scientist collaboration with a bedside-to-bench view can help enhance evidence translation and generalizability. We describe why an extension of the available evidence or generating new evidence is occasionally needed to address the increasingly diverse cohort of patients. Finally, we explore some of the tools used by basic scientists and clinicians to develop evidence and describe the ones we feel may be most beneficial.

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Trends in prevalence of comorbidities in heart failure clinical trials

Khan

Tahhan

Vaduganathan

et al. 2020

European J of Heart Fail

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AimsThe primary objective of this systematic review was to estimate the prevalence and temporal changes in chronic comorbid conditions reported in heart failure (HF) clinical trials.Methods and resultsWe searched MEDLINE for HF trials enrolling more than 400 patients published between 2001 and 2016.Trials were divided into HF with reduced ejection fraction (HFrEF), HF with preserved ejection fraction (HFpEF), or trials enrolling regardless of ejection fraction. The prevalence of baseline chronic comorbid conditions was categorized according to the algorithm proposed by the Chronic Conditions Data Warehouse, which is used to analyse Medicare data. To test for a trend in the prevalence of comorbid conditions, linear regression models were used to evaluate temporal trends in prevalence of comorbidities. Overall, 118 clinical trials enrolling a cumulative total of 215 508 patients were included. Across all comorbidities examined, data were reported in a mean of 35% of trials, without significant improvement during the study period. Reporting of comorbidities was more common in HFrEF trials (51%) compared with HFpEF trials (27%). Among trials reporting data, hypertension (63%), ischaemic heart disease (44%), hyperlipidaemia (48%), diabetes (33%), chronic kidney disease (25%) and atrial fibrillation (25%) were the major comorbidities. The prevalence of comorbidities including hypertension, atrial fibrillation and chronic kidney disease increased over time while the prevalence of smoking decreased in HFrEF trials.ConclusionMany HF trials do not report baseline comorbidities. A more rigorous, systematic, and standardized framework needs to be adopted for future clinical trials to ensure adequate comorbidity reporting and improve recruitment of multi‐morbid HF patients.

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Northern Territory Perspectives on Heart Failure with Comorbidities – Understanding Trial Validity and Exploring Collaborative Opportunities to Broaden the Evidence Base

Cited by 20 publications

References 30 publications

Health care in a globalised world: is there more than one type of patient?

Health care in a globalised world: is there more than one type of patient?

Bedside–to-Bench Translational Research for Chronic Heart Failure: Creating an Agenda for Clients who do Not Meet Trial Enrollment Criteria

Trends in prevalence of comorbidities in heart failure clinical trials

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