DRAIN: DRainage in Acute Decompensated Heart faIlure With Pleural effusioNs (DRAIN-IT)

Role of Therapeutic Thoracentesis in Hospitalized Patients With Acute Decompensated Heart Failure: Randomized Controlled Trial

The goal of this study is to assess if removal of fluid around the lungs (pleural effusion) by a routine procedure called as thoracentesis is helpful to decrease shortness of breath in hospitalized patients with congestive heart failure and have pleural effusion.

Researchers will compare thoracentesis with medical therapy to medical therapy alone to see if one treatment is superior to the other treatment in relieving shortness of breath.

Participants will :

1. Receive medical therapy with or without thoracentesis
2. Record degree of shortness of breath and quality of life before and after the intervention using predefined standard scales.
3. Telephonic call for 15- 30 mins at day 14 and 30 after enrollment to assess shortness of breath and quality of life

Study Overview

• Status: Recruiting
• Conditions: Pleural Effusion Due to Congestive Heart Failure; Congestive Heart Failure(CHF)
• Intervention / Treatment: Procedure: Thoracentesis

Detailed Description

Congestive heart failure (CHF) is the most common cause of pleural effusions.The presence of clinically significant pleural effusions in hospitalized patients with CHF has been associated with increased hospital length of stay and mortality.The treatment of CHF-related pleural effusion (CHF-PE) typically involves heart failure management such as diuresis. The role of therapeutic thoracentesis in managing heart failure-related effusions is not well established. There is only one randomized controlled trial that assessed the effect of therapeutic thoracentesis in patients with reduced left ventricular ejection fraction (≤45%) and a sizable pleural effusion. This study showed that upfront large volume thoracentesis in addition to medical therapy did not result in improved outcomes, including median days alive out of the hospital over 90 days, hospital length of stay, mortality, or quality of life. However, this trial excluded patients with heart failure with preserved ejection fraction (HFpEF). Few studies show that HFpEF is a more common and prevalent cause of heart failure-related pleural effusion as compared to those with heart failure with reduced ejection fraction (HFrEF).

In this randomized controlled trial, the investigators will compare the clinical outcomes of hospitalized patients with acute decompensated heart failure and pleural effusion who receive therapeutic thoracentesis in addition to medical therapy as compared to the no thoracentesis group.

Primary objective of this study is to assess the effect of upfront therapeutic thoracentesis in addition to the medical therapy in hospitalized patients with acute decompensated heart failure and moderate to large effusion on degree of dyspnea relief as measured by VAS score

Secondary objectives are to examine the effect of thoracentesis on secondary outcomes such as index hospital length of stay, 90-day hospital free survival, quality of life, hospital readmission rate at 90 days and complications related to thoracentesis.

• Study Type: Interventional
• Enrollment (Estimated): 216
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Amit Chopra, MD; Phone Number: 646-266-9476; Email: chopraa1@amc.edu

Study Locations

• United States
  • New York
    • Albany, New York, United States, 12211
      • Recruiting
      • Albany Medical Center
      • Contact: Katy; Phone Number: 518-262-5693; Email: ReganK@amc.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Adult patients age >18 years and.
• Clinical diagnosis of acute decompensated heart failure with at least one clinical sign of volume overload (e.g., peripheral edema, pleural effusion, or ascites) and
• Assessment of left ventricular ejection fraction (LVEF) by echocardiography performed during the time of index hospitalization or within 3 months prior to enrollment and
• Serum NT-proBNP level of >1000 pg/ml or Serum BNP>250 pg/ml at the time of enrollment and
• Radiographic evidence of moderate to large pleural effusion, defined as pleural fluid occupying more than 1/3rd of the hemithorax on chest X-ray.

Exclusion Criteria:

• Clinical indication for diagnostic thoracentesis - Presence of fever, clinical signs of infection, or atypical pleural effusion for CHF (unilateral left-sided effusion, findings suggestive of malignancy, infection, or alternative etiologies) or.
• Loculated pleural effusion - Evidence of loculated pleural effusion on thoracic ultrasound, as defined as the presence of septations or complex homogenous echogenic fluid (see Imaging Assessment section) or.
• Clinical indication for therapeutic thoracentesis - Presence of massive pleural effusion with acute respiratory failure requiring positive pressure ventilation, high-flow oxygen therapy (>15 liters per minute of flow), or tension hydrothorax (massive effusion with mediastinal shift and hemodynamic compromise) or.
• Contraindication to thoracentesis, uncontrolled bleeding diathesis, or irreversible INR > 2.0 and platelet count <50,000 or.
• Patient with mechanical mitral valve, where anticoagulation cannot be safely held or.
• Pleural procedure, such as but not limited to thoracentesis, chest tube placement, or thoracoscopy, within 3 months prior to enrollment or.
• Cardiac or thoracic surgery within 3 months prior to enrollment or.
• Requirement for chronic renal replacement therapy, such as hemodialysis or peritoneal dialysis or.
• Pregnancy or
• Inability or unwillingness to provide informed consent, or current incarceration (prisoners).

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Interventional; Thoracentesis and medical therapy	Procedure: Thoracentesis; pleural fluid will be removed
No Intervention: Medical Therapy; Only medical therapy

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Dyspnea	Degree of dyspnea will be assessed as by using a validated 100 mm visual analog scale in participants of both groups. Dyspnea will be assessed using a 100 mm visual analog scale (VAS). The VAS consisted of a horizontal straight line with endpoints defining extreme limits, with the left end marked as "no trouble" (0 mm) and the right end as "very much trouble" (100 mm). A higher VAS score indicated more severe dyspnea. The minimal clinically important difference (MCID) was defined as ≥ 14 mm improvement on this 100 mm scale, adapted from the established 24-hour VAS dyspnea threshold for clinical practicality in our setting.	30 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Proportion of patients achieved clinically significant decrease in mean VAS dyspnea score	Proportion of patients achieved clinically significant decrease in mean VAS dyspnea score over the first 30 days after the enrollment	30 days
Hospital free day at day 90	Number of hospital-free days at day 90 post-randomization, defined as the total number of days alive and not hospitalized from the date of randomization to 90 days	90 days
All-cause mortality	All cause mortality	90 days
Bendopnea	Patient will be instructed to bend forward at the waist and aim to touch ankles and maintain this position for 60 seconds. Patient will inform the investigator as soon as the dyspnea occurs, and the time of onset of bendopnoea and degree of dyspnea will be recorded.	5 days
Quality of life- KCCQ12	The investigators will use Kansas City Cardiomyopathy Questionnaire (KCCQ-12) to assess quality of life. This is based on 12 questions. Score ranges from 0 to 100. Higher score means better health.	30 days
Adverse events	Complications related to thoracentesis (Hemothorax, pneumothorax, need for additional pleural procedures) or medical therapy.	upto 30 days

Collaborators and Investigators

• Sponsor: Albany Medical College

Study record dates

Study Major Dates

• Study Start (Actual): February 15, 2026
• Primary Completion (Estimated): February 1, 2029
• Study Completion (Estimated): June 1, 2029

Study Registration Dates

• First Submitted: January 28, 2026
• First Submitted That Met QC Criteria: February 11, 2026
• First Posted (Actual): February 19, 2026

Study Record Updates

• Last Update Posted (Actual): April 30, 2026
• Last Update Submitted That Met QC Criteria: April 24, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: pleural effusion; dyspnea; congestive heart failure; hospital length of stay
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Heart Diseases; Respiratory Tract Diseases; Respiration Disorders; Signs and Symptoms, Respiratory; Pleural Diseases; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Heart Failure; Dyspnea; Pleural Effusion; Investigative Techniques; Therapeutics; Paracentesis; Specimen Handling; Clinical Laboratory Techniques; Diagnostic Techniques and Procedures; Diagnosis; Punctures; Surgical Procedures, Operative; Thoracentesis
• Other Study ID Numbers: AMC IRB# 7327; No funding (Other Identifier: No issuing organization)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No