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10. Gaps in Evidence and Ongoing Trials

The CCS HF guidelines panel identified several gaps in evidence that, when filled, will aid in the diagnosis, prognosis, treatment, or organization of care for patients with HF. These are not exhaustive and many research avenues should be pursued by the Canadian and global research community.

  1. What is the effect of using a validated risk score in clinical practice?
  2. Which current or novel therapies should be targeted for patients who present with HFmEF or HFpEF, and which biomarkers should guide these choices?
  3. What is the role of sacubitril/valsartan and other new therapies in de novo patients with HF?
  4. What are the implications of withdrawing therapy with limited or no efficacy in the current era of other therapies (eg, digoxin, statins, multivitamins)?
  5. Which of the current or novel diabetes-related therapies should be used in patients with or without diabetes and HF?
  6. What role does dietary micro- or macronutrients have on clinical outcomes for patients with HF?
  7. What is the role of antiplatelet agents (eg, aspirin) or oral anticoagulants in patients with sinus rhythm and HFrEF?
  8. Does genetic variability play a role in response to current therapy (pharmacogenomics), and can this be personalized?
  9. Should all patients with HFrEF without a known etiology undergo genetic testing?
  10. What is the role of destination therapy LV assist devices in the context of changing medical and device therapy?
  11. Should patients with a nonischemic etiology of HF receive CRT alone rather than CRT-D?
  12. What is the role of bromocriptine, other HF-related therapies, and genetic testing in patients with PPCM?
  13. What role does home-based monitoring including eHealth, telehome monitoring, mHealth, and implantable devices have on clinically relevant outcomes?
  14. What is the role of existing and novel therapies in patients with severe renal dysfunction?
  15. Are there subgroup populations who would benefit from UF?
  16. Can cellular therapies improve long-term clinical outcomes in HFrEF and if yes, which form should they take and who should be the ideal candidates?
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