International Circulation:In your opinion， what are the major barriers to clinical research of acute heart failure syndromes? What is your suggestion to overcome the problems?

《国际循环》: 在您看来，急性心力衰竭症候群临床研究的主要障碍是什么？克服这些问题您有什么建议？

Christopher O’Connor: Well there are several barriers.  Like I said we have only learned now that it is necessary to do large studies， which means you have to do global studies requiring a lot of coordination.  We don’t know what the right endpoints have been until recently.  We have been looking different endpoints such as hemodynamics， dyspnea relief， and renal function.  Probably something more robust heart failure， re-hospitalization， or death after 30 or 60 days is probably a better endpoint but a challenging one.  Not only is it influenced by the initial therapy but also influence by the transition of care.  The other barriers include the patient population， which is very heterogeneous.  There are patients with normal ejection fractions， low ejection fractions， ischemic etiology， non-ischemic etiology， there is a lot of heterogeneity in the patient populations.  It is not clear whether one drug or one device could treat all patients.  That is an important factor.  The final point I will make is that we have been relatively slow， unlike our colleagues in other disciplines， in initiating care in general.  There has been a lack of coordination with our emergency room colleagues.  Treatments， up until recently， have been delayed for 16-24 hours which shows we really need to move that to the 4-6 hour range. 

Christopher O’Connor: 有几个障碍。正如我所说我们刚刚认识到需要大型研究，这意味着需要全球性的研究，而这需要大量的合作。直到最近我们才知道正确的终点。我们一直在寻求各种终点如血液动力学、呼吸困难缓解和肾功能。或许更健全的指标如心衰、再入院、30或60天后死亡等或许是更好的终点但很有挑战性。不仅受最初治疗的影响而且也受护理转变的影响。其他的障碍包括患者群体， 有很大的异质性。在患者群体中有的射血分数正常，有的射血分数低，缺血病因和非缺血病因，在患者群中有很多的不同。还不清楚是否一种药物或仪器能治疗所有患者。那是一个很重要的因素。最后我想说的一点是与其他学科的同事相比，我们的护理启动总的来说很慢。缺乏与急诊室同事间的合作。直到最近，治疗都要延迟16-24小时
而我们确实需要提高到4-6个小时内。