INitiation and Titration of Guideline Directed Medical TheRApy in HearT Failure Cardiogenic Shock With ImpElla 5.5 for Cardiac Recovery (INTeGRATE)

September 8, 2026 updated by: Abiomed Inc.

Initiation and Titration of Guideline Directed Medical Therapy in Heart Failure Cardiogenic Shock With Impella 5.5 for Cardiac Recovery: INTeGRATE

The study will evaluate the impact of a combined device-drug strategy with Impella 5.5 with best practices and optimized GDMT on heart recovery outcomes in patients with decompensated heart failure and cardiogenic shock.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

This is a prospective, single arm, multi-center, post-market, on-label study. For patients presenting with cardiogenic shock in the setting of cardiomyopathy, including peripartum cardiomyopathy, or myocarditis (also known as decompensated heart failure complicated with cardiogenic shock, commonly referred to as heart failure-related cardiogenic shock, HF-CS, including both acute-on-chronic and de novo presentations) as a result of isolated left ventricular failure that is not responsive to optimal medical management and conventional treatment measures (including volume loading and use of pressors and inotropes, with or without IABP), an intentional device-supported strategy with Impella 5.5™ for optimization of guideline-directed medical therapy (GDMT) combined with best practices improves outcomes over standard of care.

Study Type

Interventional

Enrollment (Estimated)

250

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

  • Name: Roberta Chapman, MD, FACC, FACP, FHFSA
  • Phone Number: +1 978-882-8421
  • Email: rchapm11@its.jnj.com

Study Contact Backup

Study Locations

    • Florida
      • Tampa, Florida, United States, 33606
        • Tampa General Hospital
        • Contact:
        • Principal Investigator:
          • Debbie Rinde-Hoffman, MD, FACC, FACP, FHFSA
    • Indiana
      • Indianapolis, Indiana, United States, 46260
        • Ascension St. Vincent
        • Contact:
        • Principal Investigator:
          • Sunit-Preet Chaudhry, MD, FACC
    • Minnesota
      • Minneapolis, Minnesota, United States, 555407
        • Abbott Northwestern
        • Contact:
        • Principal Investigator:
          • Kasia Hryniewicz, MD
    • Missouri
      • St Louis, Missouri, United States, 63110
        • Barnes Jewish
        • Contact:
        • Principal Investigator:
          • Justin Vader, MD, MPHS
    • New Jersey
      • Hackensack, New Jersey, United States, 07601
        • Hackensack University Medical Center
        • Principal Investigator:
          • Kanika Mody, MD
        • Contact:
      • New Brunswick, New Jersey, United States, 08901
        • Rutgers-Robert Wood Johnson Medical School
        • Contact:
        • Principal Investigator:
          • Maya Guglin, MD, PhD
    • North Carolina
      • Charlotte, North Carolina, United States, 28204
      • Durham, North Carolina, United States, 27710
        • Duke University
        • Contact:
        • Principal Investigator:
          • Adam DeVore, MD, MHS, FHFSA, FAHA, FACC
      • Winston-Salem, North Carolina, United States, 27157
        • Wake Forest Baptist Medical Center
        • Contact:
        • Principal Investigator:
          • Olivia Gilbert, MD
    • Pennsylvania
      • Philadelphia, Pennsylvania, United States, 19104
        • University of Pennsylvania Health System
        • Contact:
        • Principal Investigator:
          • Joyce Wald, DO, FACC
      • Pittsburgh, Pennsylvania, United States, 15212
        • Allegheny General Hospital
        • Principal Investigator:
          • Matthew Lander, MD
        • Contact:
      • Pittsburgh, Pennsylvania, United States, 15213
        • UPMC Presbyterian
        • Contact:
        • Principal Investigator:
          • Sideris Facaros, MD
    • Tennessee
      • Nashville, Tennessee, United States, 32703
        • Centennial Medical Center
        • Contact:
        • Principal Investigator:
          • Thomas McRae, MD, FACC
        • Principal Investigator:
          • Zachary J II'Giovine, MD, FACC
    • Texas
      • Dallas, Texas, United States, 75243
        • Medical City Heart Hospital Dallas
        • Contact:
        • Principal Investigator:
          • Song Li, MD
    • Utah
      • Salt Lake City, Utah, United States, 84132
        • University of Utah
        • Principal Investigator:
          • Stavros Drakos, MD
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  1. Age ≥ 18 and < 80 years
  2. Subject or subject's legally authorized representative (LAR) has signed the Informed Consent Form
  3. LVEF ≤ 40%
  4. Subject is presenting with decompensated heart failure and meets at least two (2) of the following cardiogenic shock criteria:

    1. Hypotension (sustained episode of systolic blood pressure ≤ 90 mmHg for at least 30 minutes or need for inotropic/vasoactive agents to maintain such blood pressure)
    2. Hypoperfusion (physical sign(s) of organ hypoperfusion or serum lactate >2 mmol/L)
    3. Cardiac index (CI) < 2.2 L/min/m2 determined to be secondary to cardiac dysfunction, in the absence of hypovolemia
    4. Required support with an intra-aortic balloon pump (IABP) or Impella CP™
  5. Subject has inadequate heart failure GDMT based on the most recent outpatient prescription prior to index admission, defined as:

    1. On 2 or less of the 4-Pillar HF Drug Classes (BB, MRA, SGLT2i, and RASi)
    2. If on BB and RASi, at least one of the two medications is < 50% of the maximal target dose

Exclusion Criteria:

  1. Underlying unmodifiable conditions that limit initiation of GDMT prior to enrollment, including but not limited to:

    1. Drug allergies or hypersensitivities* to HF GDMT medications, unless alternative can be identified

      *Drug allergy/hypersensitivity is an immune-mediated reaction to a medication. Adverse reactions must be a result of immune or inflammatory cell stimulations by the mеԁiсаtion.

    2. Known bilateral renal artery stenosis
    3. Type 1 diabetes
    4. 2o or 3o AV block, unless pacemaker is in place
    5. Angioedema, hereditary or idiopathic
    6. Pregnancy, known or confirmed by a pregnancy test if of childbearing potential
  2. ST-segment elevation or acute coronary syndrome (ACS) prior to enrollment
  3. Septic shock, shock from non-cardiac origins, or mixed shock
  4. SCAI Stage E cardiogenic shock per study definition (Appendix C) prior to enrollment
  5. In cardiac arrest prior to enrollment
  6. Prolonged use (or use with complication) of Intra-aortic balloon pump (IABP) or Impella CP™ prior to enrollment, meeting at least one of the following:

    1. IABP use >24 hours if placed at the enrolling site or >48 hours if transferred on IABP
    2. Impella CP™ use >24 hours if placed at the enrolling site or >48 hours if transferred on Impella CP™
    3. Experienced complication(s) from IABP including clinically significant vascular injury, limb ischemia, end organ damage, or bleeding requiring transfusion(s) per Investigator's discretion
    4. Experienced complication(s) from Impella CP™ including clinically significant hemolysis, vascular injury, limb ischemia, end organ damage, or bleeding requiring transfusion(s) per Investigator's discretion
  7. On mechanical circulatory support other than IABP or Impella CP™ (i.e. ECMO, etc) or on mechanical ventilation for non-procedural reasons prior to enrollment
  8. Revascularization or cardiac surgery within 30-days prior to enrollment
  9. Infiltrative/restrictive cardiomyopathy (sarcoidosis and amyloidosis), hypertrophic cardiomyopathy, constrictive pericarditis, pericardiac tamponade, or myocarditis requiring high-dose immunosuppression
  10. Complex adult congenital heart disease
  11. Primary severe valvular disease
  12. Predominant RV dysfunction per Investigator's discretion
  13. History of heart transplant or listed for heart transplant or planned for heart transplantation prior to enrollment
  14. Planned to be implanted with a permanent VAD within 180-days of the index hospitalization date
  15. Continuous outpatient inotropic support prior to the index hospitalization date
  16. Planned to pursue palliative care or hospice, or life expectancy of less than 1 year due to non-cardiac illness at the time of index hospitalization date
  17. Currently on dialysis, or has pre-existing end-stage chronic kidney disease (stage 4 and above), or has nephropathy of hereditary, infectious, or autoimmune origin
  18. Pre-existing functional liver disease including liver cirrhosis, alcoholic hepatitis, metabolic dysfunction associated steatohepatitis (MASH), or genetic liver disease
  19. Pre-existing pulmonary disease with oxygen dependency
  20. History of stroke or intracranial hemorrhage ≤ 90 days prior to the index hospitalization date, or a history of cerebrovascular disease with significant (> 80%) uncorrected carotid stenosis, or any permanent neurological deficit with modified Rankin Scale (mRS) >2
  21. Any contraindication that precludes placing an Impella 5.5™, including but not limited to:

    1. Aortic valve stenosis/calcification with orifice area ≤ 0.6cm2 or aortic insufficiency of any grade greater than mild on pre-procedure echocardiography
    2. Presence of mechanical aortic valve or heart constrictive device
    3. Mural thrombus in the left ventricle
    4. Severe arterial disease precluding placement of Impella
    5. Presence of atrial or ventricular septal defect
    6. Left ventricular rupture
    7. Cardiac tamponade
    8. Combined cardiorespiratory failure
  22. Infection of the planned procedural access site or systemic active infection including sepsis and bacteremia
  23. Intolerance to anticoagulant or antiplatelet therapies, or will refuse blood transfusions
  24. Subject has other medical, social or psychological problems that, in the opinion of the Investigator, compromises the subject's ability to give written informed consent and/or to comply with study procedures
  25. Participation in the active treatment or follow-up phase of another clinical study of an investigational drug or device
  26. Subject belongs to a vulnerable population, such as prisoners, pregnant women, handicapped, mentally disabled persons, or economically or educationally disadvantaged persons per 21CFR56.111(a)(3) and 111(b)

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Other: Single arm study
This is a single arm study.
The intervention is Impella 5.5 with SmartAssist® support combined with protocolized guideline directed medical therapy (GDMT) and HF-CS best practices.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
Composite of all-cause death, HF hospitalization, and heart replacement (heart transplantation or durable LVAD implantation)
Time Frame: Timeframe: 180-days post-enrollment
Timeframe: 180-days post-enrollment

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Composite of all-cause death and heart replacement
Time Frame: 90-days, 180-days, 1-year post-enrollment
90-days, 180-days, 1-year post-enrollment
Composite of all-cause death, HF hospitalization, and heart replacement
Time Frame: 90-days, 1-year post-enrollment
90-days, 1-year post-enrollment
All-cause mortality
Time Frame: Hospital Discharge (within 24 hours) , 90-days, 180-days, 1-year post-enrollment
Hospital Discharge (within 24 hours) , 90-days, 180-days, 1-year post-enrollment
Cardiovascular mortality
Time Frame: Hospital Discharge (within 24 hours), 90-days, 180-days, 1-year post-enrollment
Hospital Discharge (within 24 hours), 90-days, 180-days, 1-year post-enrollment
Worsening heart failure
Time Frame: 90-days, 180-days, 1-year post-enrollment
HF hospitalization or urgent HF visit
90-days, 180-days, 1-year post-enrollment
Composite of all-cause death and worsening heart failure
Time Frame: 90-days, 180-days, 1-year post-enrollment
90-days, 180-days, 1-year post-enrollment
Non-HF cardiovascular hospitalization
Time Frame: 90-days, 180-days, 1-year post-enrollment
90-days, 180-days, 1-year post-enrollment
All cardiovascular hospitalization
Time Frame: 90-days, 180-days, 1-year post-enrollment
90-days, 180-days, 1-year post-enrollment
Composite of all-cause death and all cardiovascular hospitalization
Time Frame: 90-days, 180-days, 1-year post-enrollment
90-days, 180-days, 1-year post-enrollment
Rate of major device-related adverse events
Time Frame: Hospital Discharge (within 24 hours), 30-days post-enrollment

The composite rate of any of the following device-related serious adverse events:

  1. Major vascular access site complication
  2. Major hemolysis
  3. Bleeding, defined as MCS-ARC Type 3 or higher
  4. Structural complication requiring repair
  5. Stroke
Hospital Discharge (within 24 hours), 30-days post-enrollment
Subjects achieving indicated GDMT treatment
Time Frame: Hospital Discharge(within 24 hours), 90-days, 180-days post-enrollment
Achieving any dose of all four classes
Hospital Discharge(within 24 hours), 90-days, 180-days post-enrollment
% of Subjects achieving optimized GDMT treatment
Time Frame: 90-days and 180-days post-enrollment
Achieving at least 50% of the target dose of all four classes
90-days and 180-days post-enrollment
Modified Heart Failure Collaboratory (mHFC) score
Time Frame: Hospital Discharge(within 24 hours), 90-days, 180-days post-enrollment
Defined by HFC in 2022. Improvement from baseline
Hospital Discharge(within 24 hours), 90-days, 180-days post-enrollment
Rate of GDMT-Related Serious Adverse Events
Time Frame: Hospital Discharge (within 24 hours), 90-days, and 180-days post-enrollment

The composite rate of any of the following GDMT-related serious adverse events:

  1. Recurrence or worsening shock; symptomatic hypotension requiring admission
  2. Bradycardia requiring treatment
  3. Hyperkalemia requiring intervention
  4. Ketoacidosis requiring treatment
  5. Need for new renal replacement therapy (RRT)
Hospital Discharge (within 24 hours), 90-days, and 180-days post-enrollment
Quality of life assessed by EQ-5D
Time Frame: 180-days and 1-year post-discharge
improvement from baseline
180-days and 1-year post-discharge
6-Minute Walk Test Distance
Time Frame: 180-days and 1-year post-discharge
improvement from baseline
180-days and 1-year post-discharge
Change in LVEF from baseline
Time Frame: 180-days post-discharge
180-days post-discharge
Change in LVEDD from baseline
Time Frame: 180-days post-discharge
180-days post-discharge
Change in NYHA HF Class from baseline
Time Frame: 180-days post-discharge
180-days post-discharge
Change in HF biomarker
Time Frame: Hospital Discharge (within 24 hours), 30-days, and 90-days post-discharge
NT-proBNP from baseline
Hospital Discharge (within 24 hours), 30-days, and 90-days post-discharge

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
% of Subjects achieving optimized GDMT treatment
Time Frame: Through 1-year post-discharge
Achieving any dose of all four classes and at least 50% of the target dose of β-blocker and RASi
Through 1-year post-discharge
Modified Heart Failure Collaboratory (mHFC) score
Time Frame: Through 1-year post-discharge
Defined by HFC in 2022. Improvement from baseline
Through 1-year post-discharge
Rate of GDMT-Related Serious Adverse Events
Time Frame: Through 1-year post-discharge

The composite rate of any of the following GDMT-related serious adverse events:

  1. Recurrence or worsening shock; symptomatic hypotension requiring admission
  2. Bradycardia requiring treatment
  3. Hyperkalemia requiring intervention
  4. Ketoacidosis requiring treatment
  5. Need for new renal replacement therapy (RRT)
Through 1-year post-discharge
% of Subjects free from heart replacement
Time Frame: Through 1-year post-discharge
Freedom from durable ventricular assist device (VAD) or heart transplant (HTx)
Through 1-year post-discharge
Rate of subjects with HF hospitalization or urgent HF visit
Time Frame: Through 1-year post-discharge
Through 1-year post-discharge
% of Subjects with cardiovascular mortality and all cause mortality
Time Frame: Through 1-year post-discharge
Through 1-year post-discharge
% of Subjects with all-cause death
Time Frame: Through 1-year post-discharge
Through 1-year post-discharge
Left ventricular ejection fraction (LVEF)
Time Frame: Through 1-year post-discharge
Change from baseline
Through 1-year post-discharge
Left ventricular end-diastolic diameter (LVEDD)
Time Frame: Through 1-year post-discharge
Change from baseline
Through 1-year post-discharge
N-Terminal pro b-type natriuretic peptide (NT-proBNP)
Time Frame: Through 1-year post-discharge
Change from baseline
Through 1-year post-discharge
Quality of life assessed by Kansas City Cardiomyopathy Questionnaire (KCCQ)
Time Frame: Through 1-year post-discharge
Improvement from baseline
Through 1-year post-discharge
Quality of life assessed by EuroQoL 5-Dimensions 5-Levels (EQ-5D-5L)
Time Frame: Through 1-year post-discharge
Improvement from baseline
Through 1-year post-discharge
6-Minute Walk Test Distance
Time Frame: Through 1-year post-discharge
Improvement from baseline
Through 1-year post-discharge
New York Heart Association (NYHA) heart failure class
Time Frame: Through 1-year post-discharge
Improvement from baseline
Through 1-year post-discharge
Society for Cardiovascular Angiography & Interventions (SCAI) shock stage
Time Frame: Time of device removal
Improvement from baseline
Time of device removal
Rate of major device-related adverse events
Time Frame: Hospital discharge

The composite rate of any of the following device-related serious adverse events:

  1. Major vascular access site complication
  2. Major hemolysis
  3. Bleeding, defined as MCS-ARC Type 3 or higher
  4. Structural complication requiring repair
  5. Stroke
Hospital discharge
GDMT Optimization Change Score
Time Frame: Through 1-year post-discharge
Sum of positive therapy changes (+2 for new GDMT initiations, +1 for dose uptitration) and negative therapy changes (-2 for GDMT discontinuation, -1 for dose downtitration) from baseline
Through 1-year post-discharge

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Collaborators

Investigators

  • Principal Investigator: Adam DeVore, MD, MHS, Duke University
  • Principal Investigator: Gavin Hickey, MD, University of Pittsburgh
  • Principal Investigator: Manreet Kanwar, MD, University of Chicago

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

September 1, 2026

Primary Completion (Estimated)

December 1, 2028

Study Completion (Estimated)

June 1, 2029

Study Registration Dates

First Submitted

April 21, 2025

First Submitted That Met QC Criteria

May 2, 2025

First Posted (Actual)

May 11, 2025

Study Record Updates

Last Update Posted (Actual)

September 10, 2026

Last Update Submitted That Met QC Criteria

September 8, 2026

Last Verified

September 1, 2026

More Information

Terms related to this study

Other Study ID Numbers

  • INTeGRATE

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

Yes

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.