The TRIC-I-HF trial results may be influenced by bias due to its open-label design and the nature of the hospitalization endpoint.

The endpoint that drove the results were open to bias in this open label trial. In the win ratio, the HF hospitalization endpoint did the work: 9,280 vs 2,871 wins. Death rates were close (4,366 vs 3,166), and 74% of pairs were tied on death. Hospitalization, of course, is a clinician decision. Since everyone knows the treatment assignment, it's easy to give an increase in oral diuretics to a patient with a device while admitting a patient without one.