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Related Experiment Video

Updated: Feb 25, 2026

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

Re-Examination of the BEST Trial Using Composite Outcomes, Including Emergency Department Visits.

Li Shen¹, Pardeep S Jhund¹, Ulrik M Mogensen²

¹BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom.

JACC. Heart Failure

|August 5, 2017

Summary

This summary is machine-generated.

Choosing the right endpoint in heart failure trials significantly impacts study size and duration. Broader composite endpoints, like cardiovascular death or heart failure hospitalization, reduce trial requirements compared to mortality alone.

Keywords:

BEST endpoint heart failure recurrent events

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Area of Science:

Cardiology
Clinical Trials
Biostatistics

Background:

Endpoint selection in heart failure trials has evolved over three decades.
The Beta-blocker Evaluation of Survival Trial (BEST) provides a case study for endpoint analysis.

Purpose of the Study:

To examine the influence of endpoint choice on trial size, duration, and interpretation of results in heart failure patients.
To compare different composite endpoints and recurrent event analysis within the BEST trial.

Main Methods:

Cox regression analysis was used to compare bucindolol's effect on mortality, cardiovascular death/heart failure hospitalization (CVD/HFH), and expanded composites including ED visits.
The Lin, Wei, Ying, and Yang model was employed for recurrent event analysis.

Main Results:

The composite endpoint of CVD/HFH showed a significant benefit for bucindolol (HR: 0.80; p < 0.001) compared to placebo.
Using CVD/HFH as the endpoint instead of all-cause mortality would have reduced trial size by 40% and duration by 69%.
Recurrent CVD/HFH events also favored bucindolol (rate ratio: 0.83; p = 0.003).

Conclusions:

Endpoint selection critically influences heart failure trial logistics and outcome interpretation.
Broader composite endpoints and the analysis of recurrent events warrant further investigation in clinical trials.