Address for Correspondence:

2 Background—Many clinical trials use composite endpoints to reduce sample size, but the relative importance of each individual endpoint within the composite may differ between patients and researchers. Methods and Results—We asked 785 cardiovascular patients and 164 clinical trial authors to assign 25 “spending weights ” across 5 common adverse events comprising composite endpoints in cardiovascular trials: death, myocardial infarction (MI), stroke, coronary revascularization, and hospitalization for angina. We then calculated endpoint ratios (“ratios”) for each participant’s ratings of each nonfatal endpoint relative to death. Whereas patients assigned an average weight of 5 to death, equal or greater weight was assigned to MI (mean ratio 1.12) and stroke (ratio 1.08). In contrast, clinical trialists were much more concerned about death (average weight of 8) than MI (ratio 0.63) or stroke (ratio 0.53). Both patients and trialists considered revascularization (ratios 0.48 and 0.20, respectively) and hospitalization (ratios 0.28 and 0.13, respectively) as substantially less severe than death. Differences between patient and trialis