Acute Decompensated Heart Failure
Conditions
Brief summary
The objective of this study is to prospectively compare decongestive therapy administered by the Reprieve 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 System can more efficiently decongest ADHF patients in comparison to Control Therapy.
Interventions
DEVICEReprieve System
The Reprieve System 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.
Participants randomized to ODT will be treated with guided diuretic titration, as recommended in the ESC guidelines on diuretic therapy
Sponsors
Reprieve Cardiovascular, Inc
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
22 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Diagnosis of HF with expected hospitalization \>24 hours, with \>1 new or worsening symptom and \>2 physical examination, laboratory, or invasive findings of HF, and receiving or with plans to receive a HF-specific treatment 2. ≥10 lb. (4.5 kg) above dry weight as estimated by health care provider. 3. Current outpatient prescription for daily loop diuretic. 4. Participants ≥ 22 years of age able to provide informed consent and comply with study procedures. 5. Elevated risk of diuretic resistance, as indicated by at least one of the following: Baseline hypochloremia OR Urine output \<1L in the 6 hours following IV loop diuretic \>=40 mg furosemide equivalent OR Spot urine sodium \<100 mmol/L 1-2 hours after IV loop diuretic \>= 40 mg furosemide equivalent
Exclusion criteria
1. Urologic issues that would predispose the participant to a high rate of urogenital trauma or infection with catheter placement or known inability to place a Foley catheter. 2. Hemodynamic instability as defined by any of the following: sustained systolic blood pressure \<90 mmHg for \>15 minutes within the past 48 hours, use of IV vasopressors or inotropes within past 48 hours, and/or current or previous mechanical circulatory support within the last week. 3. Uncontrolled arrhythmias defined as sustained HR \>130 beats/min for \>10 minutes within the past 48 hours. 4. Severe lung disease with chronic home oxygen requirement \>2L/min. 5. Acute infection with evidence of systemic involvement (e.g., clinically suspected infection with fever or elevated serum white blood cell count). 6. Estimated glomerular filtration rate (eGFR) \<25 ml/min/1.73m2 (calculated with either MDRD or CKD-EPI) or current use of renal replacement therapy (RRT). 7. Significant left ventricular outflow obstruction, severe uncorrected complex congenital heart disease, known severe stenotic valvular disease, severe infiltrative or constrictive cardiomyopathy or other diagnosis that would make aggressive decongestion unsafe. 8. Current or recent (\< 30 days) type I myocardial infarction (e.g., acute coronary syndrome such as NSTEMI or STEMI from plaque rupture), coronary artery bypass surgery, or stroke. An isolated troponin elevation (e.g., from volume overload or demand ischemia) is not a reason for exclusion. 9. Severe electrolyte abnormalities (e.g., serum potassium \<3.0 mEq/L, magnesium \<1.3 mEq/L or sodium \<125 mEq/L). Note: These are based on baseline/screening labs. Participants whose electrolyte levels are repleted cannot be reassessed for inclusion in the trial. 10. Other concomitant disease or condition the investigator believes will make it difficult to follow instructions or comply with study procedures and/or follow-up visits, including expected prolonged hospitalization for reasons other than decongestive therapy 11. Currently enrolled in an interventional trial (observational studies are permitted). 12. Life expectancy less than 6 months. 13. Women who are pregnant or breastfeeding.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Hierarchical composite/win-ratio | 1. up to 30 days from randomization, 2. up to 30 days from discharge, 3. up to 72 hours after randomization | 1. Freedom from 30-day CV mortality 2. Freedom from HF Rehospitalization 30 days post-discharge 3. Greater net sodium loss per 24 hours during treatment |
| Incidence of device/procedure-related adverse events (KDIGO stage 2 or greater AKI, CAUTI) | initiation of randomized therapy through 72 hours following completion of randomized therapy | KDIGO stage 2 or greater AKI: ≥ doubling of serum creatinine or use of renal replacement therapy; CAUTI per CDC definition |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to discharge readiness | through hospital discharge, an average of 5 days | Time from initiation of randomized therapy to when the participant becomes medically ready for discharge from a decompensated heart failure treatment standpoint |
| Time on IV diuretic therapy | randomization through hospital discharge, assessed up to 30 days | — |
| Net fluid loss | per 24 hours at end of randomized therapy | Fluid input subtracted from total urine output |
| Weight loss | per 24 hours at end of randomized therapy | — |
| Tinnitus or hearing loss lasting more than 30 minutes | initiation of randomized therapy up to 12 hours after stopping randomized therapy | — |
| Length of stay | through hospital discharge, an average of 5 days | Time from initiation of randomized therapy to hospital discharge |
| Hypotension defined as systolic blood pressure < 80 mmHg documented with two readings at least 30 minutes apart with symptoms (e.g., chest pain, dizziness) or <80 mmHg requiring an intervention including IV fluids or vasopressors. | initiation of randomized therapy up to 12 hours after stopping randomized therapy | — |
| Severe electrolyte abnormality | initiation of randomized therapy up to 72 hours after stopping randomized therapy | serum potassium \<3.0 mEq/L with ≥ 0.5 mEq/L decrease from initiation of randomized therapy, magnesium \<1.3 mEq/L with ≥0.5 mEq/L decrease from initiation of randomized therapy, or sodium \<125 mEq/L with ≥ 5.0 mEq/L decrease from initiation of randomized therapy |
| Worsening heart failure requiring a higher level of HF therapy | initiation of randomized therapy up to 72 hours after stopping randomized therapy | — |
| CV mortality and cumulative HF rehospitalizations | 90 days after hospital discharge | Both types of events will be combined in a total event rate compared between groups |
| Net sodium loss | per 24 hours at end of randomized therapy | — |
Countries
Germany, Italy, Poland, Spain, United States
Contacts
Primary ContactAnnemarie Forrest
Outcome results
None listed