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Racial representation in heart failure clinical trials and registries: A systematic review and meta-analysis
Cynthia L Green1, Oludamilola Aladesanmi2, Godefroy Chery3
1Department of Biostatistics & Bioinformatics, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
Journal of the National Medical Association
|January 9, 2026
Summary
Black and underrepresented racial/ethnic groups (UREGs) are less included in heart failure (HF) registries than clinical trials. Contrary to expectations, HF registries did not improve UREG participation compared to trials.
Area of Science:
- Cardiology
- Clinical Trials
- Health Disparities
Background:
- Underrepresented racial and ethnic groups (UREGs) face a disproportionate burden of heart failure (HF).
- Historically, UREG participation in HF clinical trials has been low.
- HF registries, with broader inclusion criteria, were hypothesized to enroll more UREGs.
Purpose of the Study:
- To compare the proportion of UREGs in HF clinical trials versus HF registries.
- Utilizing a systematic review and meta-analysis to quantify participation differences.
Main Methods:
- Systematic review of randomized controlled HF trials and registries (2010-2019) from the US.
- Searched PubMed and Embase, supplemented by ClinicalTrials.gov.
- Calculated racial group percentages and performed meta-analyses to compare enrollment.
Main Results:
- Included 62 trials and 15 registries; most reported granular racial data.
- Black participants were significantly less represented in HF registries (21.8%) than trials (30.4%).
- Non-White participants were also less represented in registries (18.0%) compared to trials (24.3%), though not statistically significant.
Conclusions:
- HF registries did not show higher inclusion rates for Black and non-White patients compared to trials.
- Contrary to hypothesis, Black participants were significantly less represented in registries than trials.
- Findings highlight persistent disparities in UREG participation within HF research.
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