Acute heart failure Clinical trials Site-based research

There are more than 1 million hospitalizations for acute heart failure annually in the United States accounting for most of the $40 billion spent directly on HF-related care. Although the treatment and prognosis of ambulatory HF patients has improved dramatically because of drug- and device-based therapies, there have been few advancements in the manage-ment of AHF and postdischarge readmissions and mortality remain unacceptably high. One of the emerging trends in global clinical trials has been the gradual shift of enrollment from pre-dominantly North America andWestern Europe to Eastern Europe, South America, and Asia-Pacific where the regulatory burden and cost of conducting research may be less prohibitive. The crisis in site-based research in North America is exacerbated by poor visibility of cardiovascular disease and clinical trials, an inability to identify highly performing centers in terms of volume and quality, time-consuming study protocols not reflective of the realities of patient care, inadequate infrastructure for recruitment and study conduct, underdeveloped relationships between the research team and emergency providers and hospital-based physicians, misaligned incentives be-tween principle investigators and the parent clinical facilities, and limited training and support for study coordinators. rt fa il ur e. th ec li ni c