ReviewNature cardiovascular research2026
Strategies to improve regional representation in heart failure randomized controlled clinical trials.
Review in Nature cardiovascular research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
14 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The regional enrollment of participants in pivotal randomized controlled trials (RCTs) often does not represent the regional distribution of cardiovascular diseases. Over the past four decades, trials have enrolled participants primarily from North America and Europe, limiting the global generalizability of findings. In this Perspective, we review the evolution of regional participation in RCTs, using heart failure as a case study to assess temporal trends, current gaps in representativeness and opportunities for improvement. We assess the regulatory, logistical and financial barriers to clinical trial enrollment in underrepresented regions. We examine the manner in which global regions have been classified in trials, and propose a standardized regional classification system for reporting and subgroup analysis. To improve regional representativeness, we suggest targeted strategies that address barriers faced at the national, regulatory, sponsor or funder, institution and patient level. We also recommend the use of a representativeness index during trial planning and site selection to enhance regional representativeness. Expanding trial participation beyond historically dominant regions could be a key step in improving trial efficiency, external validity and global health equity.
Indexed as
Identifiers
41786991What Socratic holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.