{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T18:52:43Z","timestamp":1781895163195,"version":"3.54.5"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T00:00:00Z","timestamp":1780012800000},"content-version":"vor","delay-in-days":24,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Vifor International"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The DIAMOND randomized controlled trial (RCT) found patiromer to effectively reduce the risk of hyperkalaemic events among patients with heart failure (HF). However, the extent to which the RCT population reflects routine clinical practice remains unclear. We aimed to compare eligibility, clinical profile, and treatment patterns between patients enrolled in the CARE-HK registry and the DIAMOND trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>DIAMOND (NCT03888066), a Phase 3b RCT completed in 2021, and CARE-HK (NCT04864795), a non-interventional registry completed in 2024, both enrolled patients with chronic HF and either active hyperkalaemia or high risk for hyperkalaemia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Only 17.2% of CARE-HK participants met DIAMOND\u2019s eligibility criteria, dropping to 3.4% when excluding patients with missing data. Compared with DIAMOND, CARE-HK enrolled an older (71.8 vs 67.2 years), more diverse population with more women (31.5% vs 27.6%) and greater burden of comorbidities. Patients exhibited more advanced renal dysfunction, especially in the HF with reduced ejection fraction (HFrEF) population. Within CARE-HK, the use of angiotensin receptor\u2013neprilysin inhibitors (72.1% vs 17.0%), sodium\u2013glucose transport protein 2 inhibitors (69.0% vs 6.6%), and quadruple therapy (47.4% vs 3.9%) was higher in the HFrEF subgroup than in DIAMOND. Despite some progress in prescribing practices, uptake in guideline-directed medical therapy remained incomplete, especially within HFrEF, and renin\u2013angiotensin\u2013aldosterone system inhibitor dosing was often suboptimal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study underscores the value of real-world evidence in complementing RCTs by offering insights into population diversity, comorbidity burden, and prescription behaviours, and highlights the need for more pragmatic and inclusive trials in HF.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eschf\/xvag155","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T11:46:55Z","timestamp":1779968815000},"source":"Crossref","is-referenced-by-count":0,"title":["Comparative analysis of randomized versus real-world populations in heart failure: DIAMOND trial vs CARE-HK 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,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javed","family":"Butler","sequence":"additional","affiliation":[{"name":"Baylor Scott & White Research Institute , Dallas, TX ,","place":["USA"]},{"name":"Department of Medicine, University of Mississippi Medical Center , Jackson, MS ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0805-8683","authenticated-orcid":false,"given":"Stefan D","family":"Anker","sequence":"additional","affiliation":[{"name":"Department of Cardiology (CVK) of German Heart Center Charit\u00e9, German Centre for Cardiovascular Research (DZHK) Partner Site Berlin, Charit\u00e9 Universit\u00e4tsmedizin , Berlin ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen J","family":"Greene","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Duke Clinical Research Institute , Durham, NC 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