Fluid Management of Acute Decompensated Heart Failure Subjects Treated With Reprieve Decongestion Management System (DMS) (FASTR)
Fluid Management of Acute Decompensated Heart Failure Subjects Treated With Reprieve Decongestion Management System (DMS) - FASTR Trial
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Study Type
Study Type
Enrollment (Actual)
Enrollment
Phase
Phase
- Not Applicable
Contacts and Locations
Study Contact
Study Contact
- Name: Annemarie Forrest
- Phone Number: 919-943-0358
- Email: aforrest@reprievecardio.com
Study Locations
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Alabama
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Fairhope, Alabama, United States, 36532
- Eastern Shore Research Institute
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California
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Irvine, California, United States, 92697
- University of California Irvine
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District of Columbia
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Washington D.C., District of Columbia, United States, 20010
- MedStar Washington Hospital Center
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Michigan
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Ypsilanti, Michigan, United States, 48197
- Trinity Health Ann Arbor Hospital
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Missouri
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St Louis, Missouri, United States, 63130
- Washington University
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St Louis, Missouri, United States, 63130
- St. Louis VA
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North Carolina
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Durham, North Carolina, United States, 27710
- Duke University Hospital
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Greensboro, North Carolina, United States, 27401
- Cone Health
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Winston-Salem, North Carolina, United States, 27157
- Atrium Health Wake Forest Baptist Medical Center
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Ohio
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Cincinnati, Ohio, United States, 45219
- The Lindner Research Center at Christ Hospital
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Columbus, Ohio, United States, 43210
- Ohio State University Hospital
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South Carolina
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Charleston, South Carolina, United States, 29425
- Medical University of South Carolina
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Columbia, South Carolina, United States, 29203
- Prisma Health
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Texas
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Austin, Texas, United States, 78705
- Ascension Texas Cardiovascular
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Dallas, Texas, United States, 75246
- Baylor Scott & White
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Vermont
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Burlington, Vermont, United States, 05401
- University of Vermont Medical Center
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Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Hospitalized with a diagnosis of heart failure as defined by the presence of at least 1 symptom AND 1 sign.
- ≥10 pounds (4.5 kg) above dry weight either by historical weights or as estimated by health care provider.
- Prior use of loop diuretics within 30 says prior to admission.
- ≥ 18 years of age able to provide informed consent and comply with study procedures.
Exclusion Criteria:
- Inability to place Foley catheter or IV catheter.
- Hemodynamic instability.
- Dyspnea due primarily to non-cardiac causes.
- Acute infection with evidence of systemic involvement.
- Estimated glomerular filtration rate (eGFR) < 20 ml/min/1.73m2 calculated using the MDRD equation or current use of renal replacement therapy.
- 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.
- Inability to follow instructions or comply with follow-up procedures.
- 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.
- Severe electrolyte abnormalities.
- Presence of active coronavirus disease 2019 (COVID-19) infection.
- Enrollment in another interventional trial during the index hospitalization.
- Inability to return for follow-up study visits.
- Life expectancy less than 3 months.
- Women who are pregnant or intend to become pregnant.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
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Experimental: Reprieve Decongestion Management System
Subjects randomized to Reprieve System will receive personalized and optimized diuretic and saline infusion using the study device during the course of the treatment.
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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.
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Active Comparator: Optimal Diuretic Therapy
Sites will consider best practices of optimal diuretic dosing such as those demonstrated in recent randomized trials (DOSE, ADVOR, CLOROTIC) for patients randomized to control arm of the trial.
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Best practices of optimal diuretic dosing such as those demonstrated in recent randomized trials (DOSE, ADVOR, CLOROTIC).
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What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Total Urine Sodium Output
Time Frame: 24 hours post-treatment initiation
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Primary efficacy endpoint is total urine sodium output at 24 hours post-treatment initiation.
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24 hours post-treatment initiation
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Clinically Significant Acute Kidney Injury, Severe Electrolyte Abnormality, Symptomatic Hypotension or Hypertensive Emergency.
Time Frame: End of treatment, 0-72 hours.
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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.
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End of treatment, 0-72 hours.
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Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Net Fluid Loss
Time Frame: End of treatment, 0-72 hours
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Difference in the amount of net fluid removed during primary treatment
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End of treatment, 0-72 hours
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Time on IV Loop Diuretics
Time Frame: 0 hours (treatment initiation) through hospital discharge, up to 1-2 weeks
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Time from initiation of IV loop diuretics to discontinuation of IV loop diuretics
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0 hours (treatment initiation) through hospital discharge, up to 1-2 weeks
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Collaborators and Investigators
Sponsor
Sponsor
Investigators
Investigators
- Principal Investigator: James E. Udelson, MD, Division of Cardiology and the CardioVascular Center, Tufts Medical Center
Publications and helpful links
General Publications
- Udelson JE, Javaheri A, Fudim M, Damman K, Biegus J, Afzal A, Amin AN, Bensimhon D, Bischof JJ, Chung ES, Gottlieb RL, Mahler SA, Moreno JD, Ponikowski P, Rao V, Cox Z, Ivey-Miranda J, Collins S, Testani J. Fluid Management of Acute Heart Failure With the Reprieve System: The Randomized Controlled FASTR Trial. JACC Heart Fail. 2026 Apr 28:103062. doi: 10.1016/j.jchf.2026.103062. Online ahead of print.
- Cox ZL, Damman K, Testani JM. Decongestion in heart failure: medical and device therapies. Nat Rev Cardiol. 2025 Dec;22(12):961-977. doi: 10.1038/s41569-025-01152-z. Epub 2025 Apr 28.
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Actual)
Primary Completion
Study Completion (Actual)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
Other Study ID Numbers
- RCV-0006
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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