Heart Failure
Conditions
Interventions
Product Name: Metformin
Pharmaceutical Form: Tablet
INN or Proposed INN: METFORMIN HYDROCHLORIDE
CAS Number: 1115-70-4
Concentration unit: mg milligram(s)
Concentration type: equal
Concentration numbe
Sponsors
Danish Society of Cardiology, Heart Failure Working Group
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: General inclusion criteria for both H-HeFT and Met-HeFT - Patients with chronic heart failure - NYHA-class II, III or IV - LVEF 110/min) and (iiii) if treatment with ACE-inhibitor/ ARB is switched to treatment with Entresto, no new echocardiography is required and (iiiii) the echocardiography should be performed at least 3 months after CRT-implantation. - Patients should be uptitrated to recommended or maximally tolerated dose of ACE-I/ARB/ARNI (unless contraindicated) and beta-blocker (unless contraindicated). If indicated, an aldosterone receptor antagonist should be given (unless contraindicated). - A CRT device should be implanted, if indicated and accepted by the patient and patients with a CRT device should be treated for > 3 months. - Implantation of an ICD unit should be planned or already done, if indicated and accepted by the patient. The patient can be included in the study before a planned ICD implantation has been performed. - Informed consent Specific inclusion criteria for only H-HeFT: - Systolic blood pressure =100 mmHg - NT-proBNP > 350 pg/ml or BNP > 80 pg/ml (in patients treated with ARNI, NT-proBNP must be used). NT-proBNP or BNP should be measured (i) within 12 months prior to screening (ii) after uptitration of heart failure medication and at least 3 months after CRT implantation and (iii) the latest measurement before screening must be used. (iiii) If no NT-proBNP or BNP measurement is available that fulfils the above criteria, the NT-proBNP or BNP at screening must be used. Specific inclusion criteria for only Met-HeFT: Patients must have a diagnosis of diabetes or insulin resistance or diabetes risk. This includes 1 or more of any of the following: - A previous diagnosis of Diabetes type 2 at any time without Metformin treatment during the last 3 months - HbA1c = 5.5 % (= 37 mmol/mol) measured either (i) within 12 months prior to screening or (ii) at screening - Fasting P-glucose = 5.6 mmol/l measured either (i) within 12 months prior to screening or (ii) at screening (measured when the patient in stable condition / has no intercurrent illness) - Body mass index = 30 kg/m2 - If oral glucose tolerance testing (OGTT) has been performed at any time prior to screening: 2 hour P-glucose = 7.8 mmol/l - In addition, patients in Met-HeFT must have eGFR = 35 ml/min (MDRD). eGFR can be measured within 4 weeks prior to screening if the patient at the time of measurement is uptitrated to maximally tolerated/ recommended heart failure medication and clinically stable. Patients in Met-HeFT can be included regardless of NT-proBNP / BNP levels Patients are randomized to R1 and R2 through an internet based randomization module. Patients can be allocated to a) both R1 and R2 or to b) only R1 or to c) only R2. Are the trial subjects under 18? no Number of subjects for this age range: F.1.2 Adults (18-64 years) yes F.1.2.1 Number of subjects for this age range 500 F.1.3 Elderly (>=65 years) yes F.1.3.1 Number of subjects for this age range 1000
Exclusion criteria
Exclusion criteria: For both H-HeFT and Met-HeFT - Acute myocardial infarction, unstable angina or revascularization 110 beats/min) - Known hypertrophic or restrictive cardiomyopathy, infiltrative or storage myocardial disease, active myocarditis, or pericardial disease. - Listed for heart transplantation. - Female patients who are pregnant, nursing, or of childbearing potential while not practicing effective chemical contraceptive methods (i.e. oral, implanted, injectable, or transdermal contraceptive hormones; intrauterine device) - Age 3 times upper normal limit (it is possible to repeat this measurement within 3 months) - Significant comorbidity or issue which makes the patient unsuitable for participation as judged by the investigator - Participation in another double blind drug trial (participation in device studies is allowed) Only for H-HeFT - Severe, symptomatic hypotension - Contraindications to the use of hydralazine therapy - African descent - Treatment with Viagra or other PDE-5-inhibitor or soluble guanylate cyclase stimulator that cannot be discontinued - Treatment with long-acting mono- or di-nitrates, that cannot be discontinued Only for Met-HeFT - Known allergy to Metformin or major side effects to Metformin treatment - Type 1 diabetes
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Main Objective: In patients with chronic heart failure and reduced LVEF on optimal treatment: R1) Hydralazine-ISDN reduces incidence of death and hospitalization with worsening heart failure or an urgent visit resulting in intravenous therapy or metolazone therapy for heart failure or heart transplantation or implantation of a left ventricular assist device (LVAD). R2) Metformin reduces incidence of death and cardiovascular hospitalizations (worsening heart failure or heart transplantation or implantation of a left ventricular assist device (LVAD) or acute myocardial infraction or stroke) and urgent visits resulting in intravenous therapy or metolazone therapy for heart failure ;Secondary Objective: BiDil: 1. Individual components of the primary endpoint 2. Combined endpoint: Death or cardiovascular hospitalizations (hospitalization with worsening heart failure or heart transplantation or implantation of a left ventricular assist device (LVAD) or acute myocardial infarction or stroke) or an urgent visit resulting in intravenous therapy or metolazone therapy for heart failure Metformin: 1.Individual components of the primary endpoint 2.Extended clinical endpoint: The primary endpoint or coronary revascularization or non-coronary revascularization or limb amputation 3.New-onset T2D 4.Hospitalization/ death caused by: lactate acidosis. ;Primary end point(s): BiDil: Combined endpoint: Death or hospitalization with worsening heart failure or an urgent visit resulting in intravenous therapy or metolazone therapy for heart failure or heart transplantation or implantation of a left ventricular assist device (LVAD). Metformin: Combined endpoint: Death or cardiovascular hospitalizations (hospitalization with worsening heart failure or heart transplantation or implantation of a left ventricular assist device (LVAD) or acute myocardial infarction or stroke) or an urgent visit resulting in intravenous therapy or metolazone therapy for heart failure ;Timepoint(s) of eval | — |
Secondary
| Measure | Time frame |
|---|---|
| Secondary end point(s): H-HeFT 1. Individual components of the primary endpoint 2. Combined endpoint: Death or cardiovascular hospitalizations (hospitalization with worsening heart failure or heart transplantation or implantation of a left ventricular assist device (LVAD) or acute myocardial infarction or stroke or acute myocardial infarction or stroke) Metformin: 1. Extended clinical endpoint: The primary endpoint or coronary revascularization or non-coronary revascularization or limb amputation. 2. New diagnosis of diabetes mellitus 3. Hospitalization/ death due to lactate acidosis, 4. Individual components of the primary endpoint List of all endpoints evaluated by the endpoint committe: • Death (including suspected cause of death) • Hospitalization with worsening of heart failure - an urgent visit resulting in intravenous therapy or metolazone therapy for heart failure - heart transplantation or implantation of a left ventricular assist device (LVAD). • Non-fatal acute myocardial infarction • Non-fatal stroke • Coronary revascularization • Non-coronary arterial revascularization / surgery (e.g. peripheral vascular arterial surgery, carotid surgery) and limb amputations • New onset diabetes • Hospitalization/death due to lactate acidosis ;Timepoint(s) of evaluation of this end point: After a mean follow-up of 4 years, except for quality of life | — |
Countries
Denmark
Contacts
Public ContactDAN-HeFT Study Group
DAN-HeFT Study Group
Outcome results
None listed