US-based clinical registries, such as the National Cardiovascular Data Registry and Get With The Guidelines, have been instrumental in identifying and addressing gaps in quality of care for patients across the country. It is fascinating to see approaches in other countries who have developed nationwide clinical registries, inclusive of all citizens. In Sweden, clinical registries like SCAAR and SWEDEHEART, have not only been used to describe trends in nationwide clinical outcomes but are now being used as a platform for the conduct of randomized trials. With rich characterization of patients and longitudinal followup, clinical registries can be used to identify, enroll, and follow patients randomized to treatments or strategies of care that need more investigation. These innovative “randomized clinical registry studies” are being conducted in the US as well. We need more of them.