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Diagnostic Heterogeneity in Clinical Trials for Congestive Heart Failure

Paul R. Marantz, MD, MPH; Michael H. Alderman, MD; and Jonathan N. Tobin, PhD
[+] Article and Author Information

Presented in part on 18 November 1986, at the American Heart Association's fifty-ninth scientific session, Dallas, Texas.

Requests for Reprints: Paul Marantz, MD, MPH; Department of Epidemiology and Social Medicine, Montefiore Medical Center, 111 East 210th Street; Bronx, NY 10467.

Current Author Addresses: Dr. Marantz: Department of Epidemiology and Social Medicine, Montefiore Medical Center, Bronx, NY 10462. Drs. Alderman and Tobin: Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, Bronx, NY 10461.


© 1988 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1988;109(1):55-61. doi:10.7326/0003-4819-109-1-55
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There are no uniform diagnostic criteria for congestive heart failure. To determine the pattern of diagnostic criteria used, reports of 51 randomized, double-blind, placebo-controlled, clinical drug trials published between 1977 and 1985 were reviewed. Only 23 (45%) of the trials specified objective diagnostic criteria beyond treatment history, clinical diagnosis, or functional class. Of these, there were two trials each for digoxin, hydralazine, amrinone, and metoprolol; for each pair, only one study showed therapy beneficial. Of the amrinone pair, the positive study required a lower ejection fraction ( < 30% compared with < 45%) and selected patients with more clinical severity. Conversely, for metoprolol, the positive study specified a higher ejection fraction ( < 49% compared with < 35%) and selected patients with clinically milder disease, suggesting that conflicting results may relate to differences in study population. Many studies of congestive heart failure are done without explicit diagnostic criteria. Criteria lack uniformity, and such discrepancies may explain conflicting results.

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