Randomized clinical trials are the bedrock of evidence based medicine; however, some critics believe a deficiency is the inability to tease out whether the treatment works for all patients or just a subset of patients.  The adaptive enrichment design is a novel type of randomized clinical trial which provides an opportunity to build features testing this into the design.  As a motivating example, Dr. Althouse will discuss the design and rationale for the CRT in Older Heart Failure Patients using Pacemaker versus Defibrillator (CHIPPED) trial, with an explanation of special considerations and features that may be considered for other potential trials.