Evidence map›Paper›PMID 36702610›Full record

ReviewEuropean heart journal2023

Improving representativeness in trials: a call to action from the Global Cardiovascular Clinical Trialists Forum.

Lynaea Filbey, Jie Wei Zhu, Francesca D'Angelo, Lehana Thabane, Muhammad Shahzeb Khan, Eldrin Lewis, Manesh R Patel, Tiffany Powell-Wiley, J Jaime Miranda, Liesl Zuhlke and 3 more

Open access · greenAbstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in European heart journal, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 40 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
40citing papers in PubMed, 7 pooled it
19.4field-weighted citation impact, top 1% of its field
1 · What the graph read from it

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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

40 citing papers in PubMed, 7 syntheses or guidelines pooled it, 67 citations in OpenAlex.

  1. Pooled it
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  4. ​Consideration of sex/gender aspects in cardiovascular clinical trials.Clinical research in cardiology : official journal of the German Cardiac Society · 2025
    Pooled it
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  8. Trial
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  18. A comprehensive analysis of female participation in cardiovascular trials involving the WCN investigator network.Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation · 2025
    Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors at 9 institutions in 4 countries.

Lynaea FilbeyDepartment of Medicine, McMaster University, 20 Copeland Avenue, David Braley Research Building, Suite C3-117, Hamilton, ON L8L 0A3, Canada.ORCID 0000-0002-8858-7584
Jie Wei ZhuDepartment of Medicine, McMaster University, 20 Copeland Avenue, David Braley Research Building, Suite C3-117, Hamilton, ON L8L 0A3, Canada.ORCID 0000-0001-7251-8114
Francesca D'AngeloDepartment of Medicine, McMaster University, 20 Copeland Avenue, David Braley Research Building, Suite C3-117, Hamilton, ON L8L 0A3, Canada.
Lehana ThabaneResearch Institute of St. Josephs, St. Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON L8N 4A6, Canada.ORCID 0000-0003-0355-9734
Muhammad Shahzeb KhanDivision of Cardiology, Duke Clinical Research Institute, 300 W Morgan Street, Duke University School of Medicine, Durham, NC 27701, USA.
Eldrin LewisCardiovascular Division, Stanford University School of Medicine, 291 Campus Drive, Li Ka Shing Building, Stanford, CA 94305-5101, USA.
Manesh R PatelDivision of Cardiology, Duke Clinical Research Institute, 300 W Morgan Street, Duke University School of Medicine, Durham, NC 27701, USA.
Tiffany Powell-WileySocial Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 31 Center Drive, Building 31, Bethesda, MD 20892, USA.
J Jaime MirandaCRONICAS Center of Excellence in Chronic Diseases, Av. Armendariz, 2nd floor, Miraflores 15074, Lima, Peru.ORCID 0000-0002-4738-5468
Liesl ZuhlkeSouth African Medical Research Council and Division of Paediatric Cardiology, University of Cape Town and Red Cross Memorial Children's Hospital, Klipfontein Road, Rondebosch, Cape Town, Western Cape 7700, South Africa.ORCID 0000-0003-3961-2760
Javed ButlerDepartment of Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.ORCID 0000-0001-7683-4720
Faiez ZannadCentre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, 4 rue du Morvan, ILM, ground floor, Vandoeuvre-des-Nancy, Meurthe-et-Moselle 54500, France.ORCID 0000-0001-7456-1570
Harriette G C Van SpallDepartment of Medicine, McMaster University, 20 Copeland Avenue, David Braley Research Building, Suite C3-117, Hamilton, ON L8L 0A3, Canada.ORCID 0000-0002-8370-4569
McMaster University · CADuke University · USFrench Clinical Research Infrastructure Network · FRMcMaster University Medical Centre · CANational Institutes of Health · USSouth African Medical Research Council · ZAStanford University · USState Street (United States) · USUniversity of Johannesburg · ZA

Funding

Medical Research Council MR/S005242/1
6 · The paper itself

Abstract

Participants enrolled in cardiovascular disease (CVD) randomized controlled trials are not often representative of the population living with the disease. Older adults, children, women, Black, Indigenous and People of Color, and people living in low- and middle-income countries are typically under-enrolled in trials relative to disease distribution. Treatment effect estimates of CVD therapies have been largely derived from trial evidence generated in White men without complex comorbidities, limiting the generalizability of evidence. This review highlights barriers and facilitators of trial enrollment, temporal trends, and the rationale for representativeness. It proposes strategies to increase representativeness in CVD trials, including trial designs that minimize the research burden on participants, inclusive recruitment practices and eligibility criteria, diversification of clinical trial leadership, and research capacity-building in under-represented regions. Implementation of such strategies could generate better and more generalizable evidence to reduce knowledge gaps and position the cardiovascular trial enterprise as a vehicle to counter existing healthcare inequalities.

Indexed as

Cardiovascular DiseasesHealthcare DisparitiesPatient SelectionHumansRandomized Controlled Trials as TopicClinical trialsdiversityEquityHealth equity‌inclusionResearch equityTrial eligibility‌Trial representativeness

Identifiers

PMID36702610
PMCPMC10226751
OpenAlexW4318173892

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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 OpenQuestion graph.