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Iyngkaran et al. | Journal of Clinical and Translational Research 2023; 9(5): 347-356 351

Figure 3. Timelines and potential paradigms for HF with reduced ejection fraction management. The largest gap in research methodology today
has been advancing links in hypothesis-generating research and its rapid translation through benchwork. Hypothesis-generating research has its
greatest strength in qualitative methodology. Linking these qualitative methods to the bench could prove beneficial to broaden the information from
observations to guide the next steps in CHF research. This concept, in a new qualitative (research methodology) paradigm, could be contextualised
relative to the direction in the management of chronic diseases from pharmacological, device, physical, to psychological options. Particularly, when
the disease trajectory is complex and differs with individual patients. As the permutations are higher, it will thus be hard to get accurate standardisation
in CHF patients and research controls. Nonetheless, balancing control, standards, diversity in general population research, or the translational phases
could address many outstanding gaps.
Abbreviations: ARNI: Angiotensin receptor neprilysin inhibitor; DMP: Disease management program; SGLT-2: Sodium-glucose co-transporter-2.

In the last several years, the translation of ARNI and SGLT- mechanism, and narrowing down the key factors. The result is a key
2 inhibitors as novel pillars of CHF has been important. These biomarker or therapy that has a significant influence on the disease
guideline-based strategies achieved class 1A indications quickly trajectory. However, as we are realising at a population level as one
and unequivocally improved all major cardiovascular outcomes layer of a problem is unwrapped, others begin to appear. In CHF,
in trials. Nonetheless, like its predecessors, global epidemiology with success in improving the acute trajectory of the illness, chronic
suggests not all patients have seen the full benefits, highlighting latent states evolve and interspersed with the slow decline, are acute
ongoing issues in post-translational delivery that require different decompensation and costly readmissions. Let us explore a hypothetical
strategies [35,36]. Despite factoring this, it is interesting to note question, to build Class 1A evidence to prevent readmissions. At
that however, we look at the epidemiology, the size of the problem the population level from current GDMT, we need to consider that
is growing, costs are escalating and outcome improvements have there is no absolute cure for CHF. Let’s take two examples that offer
not been as significant as other conditions like rheumatic and continuous ambulatory solutions to prevent readmissions, a clinical
coronary heart diseases [5,6]. and invasive example. Both options can act as early identification
This then poses some questions as to linking clinical observations of decompensation (biomarker) and inform early escalation of acute
of the past, the present, and how we identify and shape solutions therapy (e.g., inotropy or diuresis). There have already been studies
from them. Two schools of research methodology, qualitative in this area, predominately with negative results.
and quantitative, as well as the mixed methods research (MMR) i. Chronic disease self-management (CDSM) with a health
can be applied. There are some important acknowledgements to service-supported model of care such as nurse lead home-
ponder. First, GDMTs are unequivocally based on quantitative based care. The addition of allied health support does improve
data; second, MMR research is vital for hypothesis generation, major adverse cardiovascular outcomes; however, it is
however, in the post-trial phase, the logistics of conducting resource-intensive and has not translated globally into models
randomised controlled trial (RCTs) to prove these new hypotheses of care largely from logistics. CDSM is a viable solution and
may not be feasible; third, qualitative perspectives on basic gold standard trial evidence is still a while away [2,7].
sciences, that is, qualitative molecular epidemiology is a missing ii. Device-based left ventricular filling pressure assessments are
link in this mix. Thus, the question that must be asked is why is it the closest predictors to decompensation. The evidence has
important and how do we link these different research schools to been clouded and they are also measuring events later in the
deliver guideline level evidence at the post-trial level? decompensation phase [2,38].
Class 1A evidence often has a bench and clinical journey to the Several important lessons could be learned when translating
bedside. The early stages of research are based on the focus of one controlled studies: A translation issue is difficult when
problem. The journey here is based on the traditional methodology individualising solutions, as there are many more factors to consider,
of identifying a clinical problem, identifying a pathophysiological and we still have lessons to learn on how to deliver evidence
DOI: http://dx.doi.org/10.18053/jctres.09.202305.23-00010