End points for comparative effectiveness research in heart failure.

CER for heart failure continues to evolve, including its assessment of end points. Reliance on surrogate end points is unacceptable as a means of definitively establishing comparisons of clinical effectiveness. CER needs to focus on measures that clearly reflect clinical effectiveness and safety, not just survival but also standardized assessments of health status and detailed resource utilization, and it must do so in a standardized way to allow for comparison. This strategy almost certainly requires increased reliance on prospective studies with proactive end-point capture, preferably in the setting of randomized allocation of the interventions being compared.