ABSTRACT
Clinical trial activity in cardiovascular medicine has been intensive during the past 20 years, increasingly allowing an evidence-based approach to management as outlined in this text. Most earlier trials of treatment were relatively short-term, small group studies, with various clinical endpoints, including symptomatic and functional status, exercise performance and left ventricular (LV) function assessment. More recently, a higher standard of evidence has been required, including the provision of mortality data, which has necessitated large-scale multicentre trials. This has been further encouraged, if not mandated, by the appreciation that some agents may demonstrate dissociation of treatment effects, possibly dose related, with improved short-term outcomes but adverse effects on survival with prolonged treatment. Barriers are recognized between presentation of clinical trial evidence and translation into practice, some of which may be removed through the development and implementation of best practice guidelines.
