Eplerenone in Heart Failure Treatment (INOSET)

May 17, 2016 updated by: Elpen Pharmaceutical Co. Inc.

A Non-interventional, Multicenter, Observational Clinical Trial to Assess Eplerenone Treatment in Patients With Heart Failure.

Beta-blockers should be administered to all patients with heart failure stage II to IV according to NYHA.Beta-blockers reduce mortality and hospitalizations and improve the operational phase for all categories of patients with heart failure. Since beta-blockers, only carvedilol, metoprolol, bisoprolol and recently nevimpololi have shown these benefits and so, only they have evidence to be provided.

Eplerenone is indicated, in addition to conventional therapy, for reducing the risk of cardiovascular mortality and morbidity in stable patients with left ventricular dysfunction (LVEF ≤ 40%) and clinically proven heart failure after recent myocardial infarction.

Study Overview

Status

Completed

Conditions

Detailed Description

Heart Failure (HF) As heart failure is defined as a complex clinical syndrome that can result from any structural or functional cardiac disorder and affects the ability of the ventricle to accept or eject blood. Its incidence is increasing in recent years in the Western world. It is estimated that 6% - 10% of the population over 65 suffers from heart failure. The clinical picture of heart failure is shortness of breath, fatigue tolerance restriction and fluid retention that can lead to pulmonary congestion or peripheral edema. These symptoms and signs are not required to appear all at once in each patient. Some patients simply have a reduced exercise tolerance, while others dominate the swelling and do not report dyspnea or fatigue. For the diagnosis of heart failure is necessary apart from the existence of symptoms objective confirmation cardiac dysfunction, preferably by echocardiography, or more specialized and less available methods, such as magnetic resonance imaging heart and radionuclide ventriculography.

Coronary heart disease is nowadays the dominant cause of heart failure, as 65-70% of patients with heart failure suffer from coronary disease. The cardiomyopathies and especially dilated, is the cause of heart failure in 20% of cases. The myocarditis, hyperthyroidism and abuse of ethanol, are responsible for a significant number of patients with type distending heart failure. Hypertension and valvular dominated in the past, occupy small percentage today as heart failure causes. The heart failure can be divided into right or left, depending on whether the predominant symptoms resulting from congestion of systemic or pulmonary veins, respectively. Moreover, heart failure is separated into systolic or diastolic depending on whether systolic or diastolic performance of the left ventricle is affected. In most patients with systolic heart failure and diastolic dysfunction coexist. However, in 30% of patients with heart failure is pure diastolic dysfunction.

For the diagnosis of heart failure with diastolic dysfunction criteria require:

  1. In the presence of signs and symptoms of heart failure
  2. ejection fraction of the left ventricle> 45%
  3. the presence of one of three types of abnormal left ventricular filling during diastole (relaxation extension, restrictive type).

There are four operating stages depending on the symptoms of patients with heart failure, according to the classification in NYHA (New York Heart Association). At the operational stage I patients have symptoms of heart failure at a high level of exercise, beyond the ordinary. In stage II, the symptoms appear in a regular exercise level at stage III in small fatigue, while in stage IV symptoms occur at rest, so that patients are unable to look after themselves. Medication and diet can alter the operating phase which is the patient, without any significant change occurs in ventricular performance. It is particularly interesting that there is little correlation between symptoms and systolic left ventricular performance as expressed by the ejection fraction. Thus, patients with low ejection fraction <25% can be virtually asymptomatic, while others slightly influenced ejection fraction have serious discomfort. Changes of abdominal diatasimotitas of pericardial voltage, any valvular deficiencies and especially the function of the right ventricle are those factors which together with systolic left ventricular performance determine the occurrence or not of the symptoms of heart failure patients. In heart failure the function of the left ventricle is gradually worsening even in the absence of new effect damaging agent. This is the famous remodeling (Cardiac Remodeling) of the left ventricle, during which the investigators dilatation, hypertrophy and more spherical the shape. Thus, the mechanical performance of the ventricle decreases, increasing the mitral insufficiency due to distension of the mitral annulus, and increases the parietal stress. Ventricular remodeling contribute to continuous deterioration of symptoms, despite any treatment. The activation of the neurohormonal system proved to be the most important factor in why the cardiac remodeling and the unfavorable development of heart failure. Patients with heart failure have in their plasma levels of noradrenaline, angiotensin II, aldosterone, endothelin and cytokines which may act deleteriously on the structure and functioning of the heart. The mobilization of neurohormonal mechanisms in heart failure causes fluid retention and sodium, peripheral vasoconstriction, myocardial fibrosis and toxic effect on myocardial cells, creating a vicious cycle of deteriorating architecture and performance of the failing heart.

Ejection Fraction

The relation between stroke volume, which is extruded from the left ventricle and the starting end diastole filling volume gives a measure of the contractile function of the left ventricle. Each patient with known cardiovascular disease should be subject to assessment of left ventricular function by measuring ejection fraction. Several studies have demonstrated that when the ejection fraction (LVEF), which measures the ability of the heart to eject blood into the aorta, not exceed 40% (natural rate ^ 50%) increased dramatically postinfarction mortality. The ejection fraction is a reliable prognostic indicator can be calculated by ultrasonography. The reduced ejection fraction is associated with an increased risk of life-threatening arrhythmias, heart failure and death. A low ejection fraction, particularly after myocardial infarction, is a strong indication for the administration of beta-blockers, as many studies have shown that administration of these drugs significantly reduces cardiovascular mortality.

Rationale of the study

This study intends to recruit within 6 months of clinical practice in the Greek reality regarding the data administration of eplerenone in addition to standard therapy including beta-blockers, to reduce the risk of cardiovascular mortality and morbidity in stable patients with dysfunction left ventricle (LVEF ≤ 40%) and clinically proven heart failure after recent myocardial infarction.

Study Type

Observational

Enrollment (Actual)

450

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

  • Greece
      • Alexandroupolis, Greece
        • Cardiology University Clinic
    • Attica
      • Athens, Attica, Greece
        • Gennimatas General State Hospital
    • Haidari, Athens
      • University of Athens, Attikon Hospital, Haidari, Athens, Greece, 12462
        • 2nd Cardiology Department,

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 to 90 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Sampling Method

Non-Probability Sample

Study Population

Patients with Heart Failure

Description

Inclusion Criteria:

  • Eligible ages for the study:> 18 years
  • Patients who are to receive eprelenone according to standard clinical practice
  • Patients with heart failure of ischemic / non-ischemic etiology
  • Patients receiving standard therapy including beta-blockers, to reduce the risk of cardiovascular mortality and morbidity
  • Stable patients
  • Patients with left ventricular dysfunction (LVEF ≤ 40%)
  • Patients with clinically proven heart failure after recent myocardial infarction.
  • Patients who have fully understood the study protocol and signed the consent form

Exclusion Criteria:

  • Patients <18 years
  • Hypersensitivity to eplerenone in any of the excipients
  • Patients with a serum potassium level> 5,0 mmol / L at the start of therapy
  • Patients with moderate to severe renal impairment (creatinine clearance <50 mL / min)
  • Patients with severe hepatic impairment (Child-Pugh class C)
  • Patients taking diuretics guard potassium loss or strong inhibitors of CYP3A4 (eg itraconazole, ketoconazole, ritonavir, nelfinavir, clarithromycin, telithromycin and nefazodone)
  • Patients who have not fully understood the study protocol and have not signed the consent form

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

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
Levels of Potassium (K)
Time Frame: 6 months
6 months

Secondary Outcome Measures

Outcome Measure
Time Frame
Safety assessed by number of Adverse Events reported
Time Frame: 6 months
6 months
Potassium Levels (K)
Time Frame: 6 months
6 months

Collaborators and Investigators

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

Sponsor

Elpen Pharmaceutical Co. Inc.

Investigators

  • Principal Investigator: Ioannis Parissis, MD, Cardiology Department, Attikon University Hospital of Athens

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

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

March 1, 2015

Primary Completion (Actual)

April 1, 2016

Study Completion (Actual)

April 1, 2016

Study Registration Dates

First Submitted

January 16, 2015

First Submitted That Met QC Criteria

January 21, 2015

First Posted (Estimate)

January 22, 2015

Study Record Updates

Last Update Posted (Estimate)

May 18, 2016

Last Update Submitted That Met QC Criteria

May 17, 2016

Last Verified

May 1, 2016

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 2015-PLR-EL-55

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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