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Published on: June 10, 2025

Key issues in end point selection for heart failure trials: composite end points

James D Neaton1, Gerry Gray, Bram D Zuckerman

  • 1Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota 55414, USA.

Journal of Cardiac Failure
|October 19, 2005
PubMed

Insights

Composite outcomes in heart failure trials offer higher event rates and smaller sample sizes. However, careful interpretation is needed due to potential variations in treatment effects among components.

Area of Science:

  • Cardiology
  • Clinical Trials
  • Biostatistics

Background:

  • Composite outcomes are frequently employed in heart failure clinical trials.
  • This article critically examines the benefits and drawbacks of using composite outcomes.
  • Guidelines for reporting composite outcomes are proposed, with illustrative examples.

Purpose of the Study:

  • To discuss the advantages and disadvantages of composite outcomes in heart failure trials.
  • To provide recommendations for the reporting of composite outcomes.
  • To illustrate key considerations with practical examples.

Main Methods:

  • A workshop was convened by the Heart Failure Society of America and the US Food and Drug Administration in April 2004.
  • Panel discussions focused on the application of composite outcomes in heart failure research.
  • Literature review and expert consensus informed the discussion.

Main Results:

  • Composite outcomes increase event rates and can reduce sample size if treatment effects are similar across components.
  • Interpretation challenges arise when treatment effects vary among components or disproportionately affect less severe events.
  • Focusing only on the first event in composite outcomes can lead to significant information loss.

Conclusions:

  • Composite endpoints should be utilized with caution in heart failure trials.
  • Further research is required for optimal weighting of composite outcome components.
  • Exploring methods to incorporate the entire patient event history is essential for more comprehensive trial analysis.
Abstract

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