Two editors of JACC: Heart Failure detailed how the United States has fallen behind other countries in site-based clinical research and offered suggestions on how to reinvigorate the research culture in America.

The U.S. once “led the world in the conduct of heart failure clinical trials,” wrote Christopher M. O’Connor, MD, and Michael R. Bristow, MD, PhD. But would-be researchers are now pressured to produce relative value units in the clinic and burdened by a time-consuming electronic health record. Meanwhile, their international peers benefit from greater financial incentives for research as well as less restrictive regulatory environments, the authors wrote.

Because of this, developers commonly take their new products overseas to test innovative therapies, while U.S. investigators are mostly limited to retrospective outcomes research.

To boost the number of impactful trials in the U.S.—which they believe would ultimately improve the value and volume of clinical care—the JACC editors suggested providing additional financial and professional rewards for study coordinators and investigators, requiring a minimum of six months of site-based clinical research during fellowship programs and providing academic rewards such as promotion and eventual tenure to site-based investigators affiliated with academic institutions.

“We have shown that research conducted in the United States has excellent quality, high expectations, and rigorous oversight,” O’Connor and Bristow wrote. “We have to find a way to evoke a cultural transformation that leads to a greater degree of enthusiasm for participation in site-based research, because our patients expect and deserve the very best care that progress and innovation can provide.”

Read their full paper below: