Successful treatment of patients with cardiovascular disease (CVD) has markedly improved through the deployment of new therapies typically evaluated in large randomized controlled trials to provide evidence-based guidance. While this approach has reduced morbidity and mortality, the total burden of CVD maintains an upward trajectory as the population ages and developing countries adopt a Western lifestyle. Further, patients who now frequently survive an acute cardiac event often subsequently require long-term treatment for chronic conditions (e.g. chronic heart failure [HF]).

Chronic heart failure trials have led to several successes, but also to at least as many failures. In HF with reduced ejection fraction (HFrEF) the many ‘failed trials’ suggest it is likely better targeting of enrolled patient populations to fit the mechanism of action of many potential therapeutic agents could...

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