Acute Decompensated Heart Failure
Conditions
Brief summary
The objective of this study is to prospectively compare decongestive therapy administered by the Reprieve DMS system to Optimal Diuretic Therapy (ODT) in the treatment of patients diagnosed with acute decompensated heart failure (ADHF). The main objective is to determine if the Reprieve DMS can more efficiently decongest ADHF patients in comparison to Control Therapy.
Interventions
The Reprieve Decongestion Management System, or Reprieve DMS, is a hospital bedside fluid management console designed to provide personalized and automated infusion of the IV diuretic furosemide and physiological saline in response to the patient's real-time urine output to safely and rapidly decongest patients suffering from Acute Decompensated Heart Failure.
DRUGDiuretic
Best practices of optimal diuretic dosing such as those demonstrated in recent randomized trials (DOSE, ADVOR, CLOROTIC).
Sponsors
Reprieve Cardiovascular, Inc
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Hospitalized with a diagnosis of heart failure as defined by the presence of at least 1 symptom AND 1 sign. 2. ≥10 pounds (4.5 kg) above dry weight either by historical weights or as estimated by health care provider. 3. Prior use of loop diuretics within 30 says prior to admission. 4. ≥ 18 years of age able to provide informed consent and comply with study procedures.
Exclusion criteria
1. Inability to place Foley catheter or IV catheter. 2. Hemodynamic instability. 3. Dyspnea due primarily to non-cardiac causes. 4. Acute infection with evidence of systemic involvement. 5. Estimated glomerular filtration rate (eGFR) \< 20 ml/min/1.73m2 calculated using the MDRD equation or current use of renal replacement therapy. 6. Significant left ventricular outflow obstruction, uncorrected complex congenital heart disease, severe stenotic valvular disease, infiltrative or constrictive cardiomyopathy, acute myocarditis, type 1 acute myocardial infarction requiring treatment, or any other pathology that, in the opinion of the investigator, would make aggressive diuresis poorly tolerated. 7. Inability to follow instructions or comply with follow-up procedures. 8. Other concomitant disease or condition that investigator deems unsuitable for the study, including drug or alcohol abuse or psychiatric, behavioral or cognitive disorders, sufficient to interfere with the patient's ability to understand and comply with the study instructions or follow-up procedures. 9. Severe electrolyte abnormalities. 10. Presence of active coronavirus disease 2019 (COVID-19) infection. 11. Enrollment in another interventional trial during the index hospitalization. 12. Inability to return for follow-up study visits. 13. Life expectancy less than 3 months. 14. Women who are pregnant or intend to become pregnant.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total urine sodium output | 24 hours post-treatment initiation | Primary efficacy endpoint is total urine sodium output at 24 hours post-treatment initiation. |
| Clinically significant acute kidney injury, severe electrolyte abnormality, symptomatic hypotension or hypertensive emergency. | Through study completion, an average of 90 days | Primary safety endpoint includes clinically significant acute kidney injury defined as KDIGO stage 2 or greater AKI \[≥ doubling of baseline serum creatinine or use of renal replacement therapy (RRT)\], severe electrolyte abnormality (serum potassium \<3.0 mEq/L, magnesium \<1.3 mEq/L or sodium \<125 mEq), symptomatic hypotension or hypertensive emergency. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Net fluid loss | End of treatment, an average of 72 hours | Difference in the amount of net fluid removed during primary treatment |
| Time on loop diuretics | End of treatment, an average of 72 hours | Total time on loop diuretics during primary treatment |
Countries
United States
Outcome results
None listed