- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00904488
Oral Metolazone and Intermittent Intravenous Furosemide Versus Continuous Infusion Furosemide in Acute Heart Failure
February 13, 2018 updated by: University of North Carolina, Chapel Hill
Addition of Oral Metolazone to Intermittent Intravenous Furosemide Versus Transition to Continuous Infusion Furosemide in Acute Decompensated Heart Failure Patients Experiencing an Inadequate Response to Therapy
The purpose of this prospective, randomized, open-label study is to compare two diuretic strategies in patients with acute decompensated heart failure (ADHF): the addition of an oral thiazide diuretic to intravenous bolus (IVB) loop diuretic will be compared to transition from IVB to continuous infusion (CI) loop diuretic.
Study Overview
Status
Terminated
Conditions
Intervention / Treatment
Detailed Description
Patients hospitalized for ADHF secondary to fluid overload and who are experiencing an inadequate response to IVB furosemide and require additional diuresis will be enrolled.
Patients will be randomized to one of two treatment arms: the addition of oral metolazone to continued IVB furosemide versus transition from IVB to CI furosemide.
A suggested algorithm for initial dosing and titration of these two diuretic strategies will be provided.
Baseline and daily data collection will include various efficacy and safety endpoints including daily net urine output and weight, patient and physician global assessment scale, length of stay, 30-day death or rehospitalization, vital signs, electrolytes, and renal function.
Clinically meaningful efficacy and safety endpoints will be compared.
Study Type
Interventional
Enrollment (Actual)
11
Phase
- Phase 4
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
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North Carolina
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Chapel Hill, North Carolina, United States, 27599
- UNC_Chapel Hill
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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
18 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Greater than or equal to 18 years of age
Hospitalized for acute decompensated heart failure (ADHF) secondary to fluid overload as defined by the presence of at least
- 1 symptom (e.g. dyspnea, orthopnea, paroxysmal nocturnal dyspnea) AND
- 1 sign (e.g. rales on auscultation, > 2+ peripheral or presacral> edema, hepatomegaly, ascites, jugular vein distension > 7 cm, pulmonary vascular congestion on chest radiography)
- Inadequate response to IV diuretics and requiring additional diuresis as determined by primary medical team
- Received less than six doses of IV furosemide OR enrolled within 72 hours of hospital admission
- Anticipated need for intravenous diuretic therapy for at least 48 hours
- Able to provide informed consent
Exclusion Criteria:
- Receiving a continuous infusion loop diuretic during current hospital visit
- Substantial diuretic response to pre-randomization diuretic dosing such that higher doses of diuretic would be contraindicated (based on judgement of patient's primary team)
- Planned or ongoing intravenous vasoactive therapy (e.g. inotrope, vasodilator) or mechanical support (e.g. intra-aortic balloon pump, ventricular assist device) for ADHF during this hospitalization
- Planned elective admission for elective placement/revision of a cardiovascular device (e.g. defibrillator, biventricular pacemaker) during this hospitalization or such within the preceding 7 days
- Systolic blood pressure < 90 mmHg
- Serum creatinine > 3 mg/dL at baseline or renal replacement therapy including ultrafiltration
- Serum potassium < 3.5 mEq/L (3.0 - 3.4 mEq/L allowed if supplemental potassium is being administered)
- Serum magnesium < 1.6 mg/dL (1.4 - 1.5 mg/dL allowed if supplemental magnesium is being administered)
- Acute coronary syndrome or hemodynamically significant arrhythmias causing worsening HF
- Severe, uncorrected primary cardiac valvular disease, acute myocarditis, constrictive pericarditis, hypertrophic obstructive cardiomyopathy, restrictive or constrictive cardiomyopathy, complex congenital heart disease
- Primary pulmonary hypertension with right sided heart failure
- Use of iodinated radiocontrast material in prior 72 hours or planned within the next 48 hours
- Enrollment or planned enrollment in another randomized clinical trial during hospitalization
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: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Addition of PO Thiazide Diuretic
Addition of oral metolazone 5 mg daily to current intravenous bolus furosemide.
All subjects will continue their current dose of intravenous bolus furosemide.
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Addition of oral metolazone 5 mg daily to continued current dose of intravenous bolus furosemide
Other Names:
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Active Comparator: IV furosemide dose escalation
Current IV furosemide dose will be escalated to 2-2.5 x current dose, given as either IV bolus or continuous infusion over 24 hours.
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Furosemide dose escalation via either IV bolus (2-2.5 x current dose) or continuous infusion (2-2.5 x current dose administered over previous 24 hours)
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Daily Net Fluid Output on Day 2 (24-48 Hours After Randomization)
Time Frame: 24-48 hours
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Net fluid output = fluid output during 24-48 hours after randomization - fluid intake during 24-48 hours after randomization.
A negative value means that daily fluid intake was less than the daily fluid output.
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24-48 hours
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Daily Net Fluid Output on Days 1, 3, and 4
Time Frame: 0-24, 48-72, 72-96 hrs
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Daily net fluid output = daily fluid output - daily intake.
A negative value means that daily fluid intake was less than the daily fluid output.
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0-24, 48-72, 72-96 hrs
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Daily Urine Output (mL Urine Out Per mg Furosemide (IV Equivalent) Received)
Time Frame: 0-24, 24-48, 48-72, 72-96 hrs
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0-24, 24-48, 48-72, 72-96 hrs
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Daily Weight
Time Frame: Baseline (Dry), Baseline, 0-24, 24-48, 48-72, 72-96 hrs
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Baseline (Dry), Baseline, 0-24, 24-48, 48-72, 72-96 hrs
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Patient Global Assessment Scale
Time Frame: Baseline, 24, 48, 72, 96 hrs
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Scale range: 1-5 Which of the following best describes your overall health state today?
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Baseline, 24, 48, 72, 96 hrs
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Physician Global Assessment Scale
Time Frame: Baseline, 24, 48, 72, 96 hours
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Scale range: 1-5 Which of the following best describes the patient's overall health state today?
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Baseline, 24, 48, 72, 96 hours
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Need for Additional or Alternative Diuretic (Crossover) or Other Vasoactive Therapy (Study Failure)
Time Frame: 0-96 hours
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Patients will be considered a treatment failure if they require additional diuretic (including crossover to the alternative study arm) or require IV vasoactive drug therapy (e.g.
vasodilators including nitroglycerin or inotropes) as deemed appropriate/necessary by their medical team.
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0-96 hours
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Time to Return to Baseline Weight
Time Frame: 0-96 hours
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0-96 hours
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Length of Hospitalization
Time Frame: Assessed till hospital discharge, an average of 1 week (longest 29 days)
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Assessed till hospital discharge, an average of 1 week (longest 29 days)
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30-day All-cause Mortality
Time Frame: 30 days
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30 days
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Rehospitalization at 30 Days
Time Frame: 30 days
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30 days
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Unscheduled Heart Failure Visits to Emergency Department or Outpatient Clinic
Time Frame: 30 days
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30 days
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Blood Urea Nitrogen (BUN)
Time Frame: Baseline, 24, 48, 72, 96 hours
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Baseline, 24, 48, 72, 96 hours
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Investigators
- Principal Investigator: Jo E. Rodgers, PharmD, University of North Carolina, Chapel Hill
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 (Actual)
October 1, 2008
Primary Completion (Actual)
May 28, 2016
Study Completion (Actual)
November 14, 2017
Study Registration Dates
First Submitted
May 17, 2009
First Submitted That Met QC Criteria
May 18, 2009
First Posted (Estimate)
May 19, 2009
Study Record Updates
Last Update Posted (Actual)
March 13, 2018
Last Update Submitted That Met QC Criteria
February 13, 2018
Last Verified
January 1, 2018
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Heart Diseases
- Cardiovascular Diseases
- Heart Failure
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Antihypertensive Agents
- Natriuretic Agents
- Membrane Transport Modulators
- Diuretics
- Sodium Chloride Symporter Inhibitors
- Sodium Potassium Chloride Symporter Inhibitors
- Furosemide
- Metolazone
Other Study ID Numbers
- 08-1292
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.
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