Initiering og titrering af retningslinje rettet medicinsk terapi i hjertesvigt kardiogent chok med Empella 5.5 til hjerteinddrivelse (integreret) (INTeGRATE)
Initiering og titrering af retningslinje rettet medicinsk terapi i hjertesvigt kardiogent chok med impona 5.5 til hjerteinddrivelse: integrere
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.
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Detaljeret beskrivelse
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.
Undersøgelsestype
Undersøgelsestype
Tilmelding (Anslået)
Tilmelding
Fase
Fase
- Ikke anvendelig
Kontakter og lokationer
Studiekontakt
Studiekontakt
- Navn: Roberta Chapman, MD, FACC, FACP, FHFSA
- Telefonnummer: +1 978-882-8421
- E-mail: rchapm11@its.jnj.com
Undersøgelse Kontakt Backup
- Navn: Stacie Hallaway
- Telefonnummer: 839-216-3087
- E-mail: shallawa@its.jnj.com
Studiesteder
-
-
California
-
Sacramento, California, Forenede Stater, 95816
- Ikke rekrutterer endnu
- Sutter Medical Center Sacramento
-
Ledende efterforsker:
- Michael Gibson, MD
-
Kontakt:
- Bonnie Chan
- Telefonnummer: 415-463-0379
- E-mail: bonnie.chan2@sutterhealth.org
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San Francisco, California, Forenede Stater, 94110
- Ikke rekrutterer endnu
- California Pacific Medical Center
-
Kontakt:
- Bonnie Chan
- Telefonnummer: 415-463-0379
- E-mail: bonnie.chan2@sutterhealth.org
-
Ledende efterforsker:
- Jared Herr, MD
-
Ledende efterforsker:
- Michael Pham, M.D., FACC, MPH
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Florida
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Naples, Florida, Forenede Stater, 34102
- Ikke rekrutterer endnu
- NCH Rooney Heart Institute
-
Kontakt:
- Kathy Byrd
- Telefonnummer: 239-624-8113
- E-mail: kathy.byrd@nchmd.org
-
Ledende efterforsker:
- Viviana Navas, MD
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Tampa, Florida, Forenede Stater, 33606
- Rekruttering
- Tampa General Hospital
-
Kontakt:
- Courtney Nicholas, BS RN, CCRP, CVRN-BC
- Telefonnummer: 813-844-4914
- E-mail: courtneynicholas@tgh.org
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Ledende efterforsker:
- Debbie Rinde-Hoffman, MD, FACC, FACP, FHFSA
-
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Indiana
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Indianapolis, Indiana, Forenede Stater, 46260
- Ikke rekrutterer endnu
- Ascension St. Vincent
-
Kontakt:
- Jennifer Brown
- Telefonnummer: 317-338-6439
- E-mail: Jennifer.Brown4@ascension.org
-
Ledende efterforsker:
- Sunit-Preet Chaudhry, MD, FACC
-
-
Minnesota
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Minneapolis, Minnesota, Forenede Stater, 555407
- Rekruttering
- Abbott Northwestern
-
Kontakt:
- Juilanne Feola
- Telefonnummer: 612-863-6066
- E-mail: julianne.feola@allina.com
-
Ledende efterforsker:
- Kasia Hryniewicz, MD
-
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Missouri
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St Louis, Missouri, Forenede Stater, 63110
- Ikke rekrutterer endnu
- Barnes Jewish
-
Kontakt:
- Jean Flanagan
- Telefonnummer: 314-454-7451
- E-mail: jflanaga@wustl.edu
-
Ledende efterforsker:
- Justin Vader, MD, MPHS
-
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New Jersey
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Hackensack, New Jersey, Forenede Stater, 07601
- Ikke rekrutterer endnu
- Hackensack University Medical Center
-
Ledende efterforsker:
- Kanika Mody, MD
-
Kontakt:
- Manuel Castillo
- Telefonnummer: 551-996-2136
- E-mail: manuel.castillo@hmhn.org
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New Brunswick, New Jersey, Forenede Stater, 08901
- Rekruttering
- Rutgers-Robert Wood Johnson Medical School
-
Kontakt:
- Manisha Bajpai, MD
- Telefonnummer: 732-258-3649
- E-mail: bajpaima@rwjms.rutgers.edu
-
Ledende efterforsker:
- Maya Guglin, MD, PhD
-
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New York
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New York, New York, Forenede Stater, 10032
- Ikke rekrutterer endnu
- New York Presbyterian - Columbia
-
Ledende efterforsker:
- Adil Yunis, MD
-
Kontakt:
- Jessica Idumonyi
- Telefonnummer: (212) 305-1429
- E-mail: joi2102@cumc.columbia.edu
-
Valhalla, New York, Forenede Stater, 10595
- Ikke rekrutterer endnu
- Westchester Medical Center
-
Ledende efterforsker:
- Alan Gass, MD
-
Kontakt:
- Rajkumari Bhardwa
- Telefonnummer: 914-493-5599
- E-mail: Rajkumari.Bhardwaj@wmchealth.org
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North Carolina
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Charlotte, North Carolina, Forenede Stater, 28204
- Ikke rekrutterer endnu
- Atrium Health- Sanger Heart and Vascular Institute
-
Kontakt:
- Haley Bonilla
- Telefonnummer: 704-468-3193
- E-mail: haley.bonilla@atriumhealth.org
-
Ledende efterforsker:
- Priyesh Patel, M.D.
-
Durham, North Carolina, Forenede Stater, 27710
- Ikke rekrutterer endnu
- Duke University
-
Kontakt:
- Elyse Wilson
- Telefonnummer: (919) 681-8879
- E-mail: elyse.wilson@duke.edu
-
Ledende efterforsker:
- Adam DeVore, MD, MHS, FHFSA, FAHA, FACC
-
Winston-Salem, North Carolina, Forenede Stater, 27157
- Ikke rekrutterer endnu
- Wake Forest Baptist Medical Center
-
Kontakt:
- Karen Blinson Research Coordinator
- Telefonnummer: 336-716-5706
- E-mail: karen.blinson@advocatehealth.org
-
Ledende efterforsker:
- Olivia Gilbert, MD
-
-
Oklahoma
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Tulsa, Oklahoma, Forenede Stater, 74136
- Ikke rekrutterer endnu
- Saint Francis Hospital - Tulsa
-
Ledende efterforsker:
- Jaime Hernandez-Montfort, MD
-
Kontakt:
- Jennifer Nangle
- Telefonnummer: 918-502-1603
- E-mail: jnangle@saintfrancis.com
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Oregon
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Portland, Oregon, Forenede Stater, 97225
- Ikke rekrutterer endnu
- Providence St. Vincent Medical Center
-
Kontakt:
- Sarah Jackson
- Telefonnummer: 503-216-7370
- E-mail: sarah.jackson3@providence.org
-
Ledende efterforsker:
- Vidang Nguyen, MD
-
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Pennsylvania
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Philadelphia, Pennsylvania, Forenede Stater, 19104
- Ikke rekrutterer endnu
- University of Pennsylvania Health System
-
Kontakt:
- Alyson Brown
- Telefonnummer: 215-662-2128
- E-mail: alyson.brown@pennmedicine.upenn.edu
-
Ledende efterforsker:
- Joyce Wald, DO, FACC
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Pittsburgh, Pennsylvania, Forenede Stater, 15212
- Ikke rekrutterer endnu
- Allegheny General Hospital
-
Ledende efterforsker:
- Matthew Lander, MD
-
Kontakt:
- Laurie Machen
- Telefonnummer: 412-359-6181
- E-mail: Laurie.Machen@ahn.org
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Pittsburgh, Pennsylvania, Forenede Stater, 15213
- Ikke rekrutterer endnu
- UPMC Presbyterian
-
Kontakt:
- Traci Mc Gaha
- Telefonnummer: 412-692-2769
- E-mail: mcgahatl4@upmc.edu
-
Ledende efterforsker:
- Sideris Facaros, MD
-
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Tennessee
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Nashville, Tennessee, Forenede Stater, 32703
- Ikke rekrutterer endnu
- Centennial Medical Center
-
Kontakt:
- Kristen Kuhn
- Telefonnummer: 615.982.0640
- E-mail: kristen.kuhn2@hcahealthcare.com
-
Ledende efterforsker:
- Thomas McRae, MD, FACC
-
Ledende efterforsker:
- Zachary J II'Giovine, MD, FACC
-
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Texas
-
Dallas, Texas, Forenede Stater, 75243
- Rekruttering
- Medical City Heart Hospital Dallas
-
Kontakt:
- Lauren Horton
- Telefonnummer: 469-887-3274
- E-mail: lauren.horton2@hcahealthcare.com
-
Ledende efterforsker:
- Song Li, MD
-
-
Utah
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Salt Lake City, Utah, Forenede Stater, 84132
- Ikke rekrutterer endnu
- University of Utah
-
Ledende efterforsker:
- Stavros Drakos, MD
-
Kontakt:
- Ashley Elmer
- Telefonnummer: 801.585.6775
- E-mail: ashley.elmer@hsc.utah.edu
-
Ledende efterforsker:
- Thomas Hanff, MD
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Virginia
-
Falls Church, Virginia, Forenede Stater, 22042
- Ikke rekrutterer endnu
- Inova Fairfax Hospital
-
Ledende efterforsker:
- Shashank Sinha, MD
-
Kontakt:
- Bhruga Shah
- Telefonnummer: 703-776-2828
- E-mail: Bhruga.shah@inova.org
-
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Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Beskrivelse
Inclusion Criteria:
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Age ≥ 18 and < 80 years
-
Subject or subject's legally authorized representative (LAR) has signed the Informed Consent Form
-
LVEF ≤ 40%
-
Subject is presenting with decompensated heart failure and meets at least two (2) of the following cardiogenic shock criteria:
- 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)
- Hypoperfusion (physical sign(s) of organ hypoperfusion or serum lactate >2 mmol/L)
- Cardiac index (CI) < 2.2 L/min/m2 determined to be secondary to cardiac dysfunction, in the absence of hypovolemia
- Required support with an intra-aortic balloon pump (IABP) or Impella CP™
-
Subject has inadequate heart failure GDMT based on the most recent outpatient prescription prior to index admission, defined as:
- On 2 or less of the 4-Pillar HF Drug Classes (BB, MRA, SGLT2i, and RASi)
- If on BB and RASi, at least one of the two medications is < 50% of the maximal target dose
Exclusion Criteria:
-
Underlying unmodifiable conditions that limit initiation of GDMT prior to enrollment, including but not limited to:
-
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.
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Known bilateral renal artery stenosis
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Type 1 diabetes
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2o or 3o AV block, unless pacemaker is in place
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Angioedema, hereditary or idiopathic
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Pregnancy, known or confirmed by a pregnancy test if of childbearing potential
-
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ST-segment elevation or acute coronary syndrome (ACS) prior to enrollment
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Septic shock, shock from non-cardiac origins, or mixed shock
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SCAI Stage E cardiogenic shock per study definition (Appendix C) prior to enrollment
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In cardiac arrest prior to enrollment
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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:
- IABP use >24 hours if placed at the enrolling site or >48 hours if transferred on IABP
- Impella CP™ use >24 hours if placed at the enrolling site or >48 hours if transferred on Impella CP™
- Experienced complication(s) from IABP including clinically significant vascular injury, limb ischemia, end organ damage, or bleeding requiring transfusion(s) per Investigator's discretion
- 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
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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
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Revascularization or cardiac surgery within 30-days prior to enrollment
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Infiltrative/restrictive cardiomyopathy (sarcoidosis and amyloidosis), hypertrophic cardiomyopathy, constrictive pericarditis, pericardiac tamponade, or myocarditis requiring high-dose immunosuppression
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Complex adult congenital heart disease
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Primary severe valvular disease
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Predominant RV dysfunction per Investigator's discretion
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History of heart transplant or listed for heart transplant or planned for heart transplantation prior to enrollment
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Planned to be implanted with a permanent VAD within 180-days of the index hospitalization date
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Continuous outpatient inotropic support prior to the index hospitalization date
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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
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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
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Pre-existing functional liver disease including liver cirrhosis, alcoholic hepatitis, metabolic dysfunction associated steatohepatitis (MASH), or genetic liver disease
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Pre-existing pulmonary disease with oxygen dependency
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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
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Any contraindication that precludes placing an Impella 5.5™, including but not limited to:
- Aortic valve stenosis/calcification with orifice area ≤ 0.6cm2 or aortic insufficiency of any grade greater than mild on pre-procedure echocardiography
- Presence of mechanical aortic valve or heart constrictive device
- Mural thrombus in the left ventricle
- Severe arterial disease precluding placement of Impella
- Presence of atrial or ventricular septal defect
- Left ventricular rupture
- Cardiac tamponade
- Combined cardiorespiratory failure
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Infection of the planned procedural access site or systemic active infection including sepsis and bacteremia
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Intolerance to anticoagulant or antiplatelet therapies, or will refuse blood transfusions
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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
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Participation in the active treatment or follow-up phase of another clinical study of an investigational drug or device
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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)
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: N/A
- Interventionel model: Enkelt gruppeopgave
- Maskning: Ingen (Åben etiket)
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
|---|---|
|
Andet: 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. |
Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Tidsramme |
|---|---|
|
Sammensat af dødsfald uanset årsag, hospitalsindlæggelse for hjertesvigt og hjerteerstatning (hjertetransplantation eller implantation af varig LVAD)
Tidsramme: Tidsramme: 180 dage efter tilmelding
|
Tidsramme: 180 dage efter tilmelding
|
Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Samlet sammensætning af død af alle årsager og hjerteerstatning
Tidsramme: 90 dage, 180 dage, 1 år efter tilmelding
|
90 dage, 180 dage, 1 år efter tilmelding
|
|
|
Sammensætning af dødsfald af alle årsager, HF-hospitalisering og hjerterstatning
Tidsramme: 90 dage, 1 år efter indskrivning
|
90 dage, 1 år efter indskrivning
|
|
|
Dødelighed uanset årsag
Tidsramme: Indlæggelsesudskrivelse (inden for 24 timer), 90 dage, 180 dage, 1 år efter tilmelding
|
Indlæggelsesudskrivelse (inden for 24 timer), 90 dage, 180 dage, 1 år efter tilmelding
|
|
|
Kardiovaskulær dødelighed
Tidsramme: Udlæggelse fra hospital (inden for 24 timer), 90 dage, 180 dage, 1 år efter indskrivning
|
Udlæggelse fra hospital (inden for 24 timer), 90 dage, 180 dage, 1 år efter indskrivning
|
|
|
Sammensat af død uanset årsag og forværring af hjertesvigt
Tidsramme: 90 dage, 180 dage, 1 år efter tilmelding
|
90 dage, 180 dage, 1 år efter tilmelding
|
|
|
Ikke-HF kardiovaskulær indlæggelse
Tidsramme: 90 dage, 180 dage, 1 år efter tilmelding
|
90 dage, 180 dage, 1 år efter tilmelding
|
|
|
Alle hjerte-kar-indlæggelser
Tidsramme: 90 dage, 180 dage, 1 år efter tilmelding
|
90 dage, 180 dage, 1 år efter tilmelding
|
|
|
Sammensat af død uanset årsag og alle kardiovaskulære indlæggelser
Tidsramme: 90 dage, 180 dage, 1 år efter tilmelding
|
90 dage, 180 dage, 1 år efter tilmelding
|
|
|
Ændring i LVEF fra baseline
Tidsramme: 180 dage efter udskrivelse
|
180 dage efter udskrivelse
|
|
|
Ændring i LVEDD fra baseline
Tidsramme: 180 dage efter udskrivelse
|
180 dage efter udskrivelse
|
|
|
Ændring i NYHA HF Klasse fra baseline
Tidsramme: 180 dage efter udskrivelse
|
180 dage efter udskrivelse
|
|
|
Worsening heart failure
Tidsramme: 90-days, 180-days, 1-year post-enrollment
|
HF hospitalization or urgent HF visit |
90-days, 180-days, 1-year post-enrollment
|
|
Rate of major device-related adverse events
Tidsramme: Hospital Discharge (within 24 hours), 30-days post-enrollment
|
The composite rate of any of the following device-related serious adverse events:
|
Hospital Discharge (within 24 hours), 30-days post-enrollment
|
|
Subjects achieving indicated GDMT treatment
Tidsramme: 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
Tidsramme: 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
Tidsramme: 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
Tidsramme: 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:
|
Hospital Discharge (within 24 hours), 90-days, and 180-days post-enrollment
|
|
Quality of life assessed by EQ-5D
Tidsramme: 180-days and 1-year post-discharge
|
improvement from baseline |
180-days and 1-year post-discharge
|
|
6-Minute Walk Test Distance
Tidsramme: 180-days and 1-year post-discharge
|
improvement from baseline |
180-days and 1-year post-discharge
|
|
Change in HF biomarker
Tidsramme: 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
|
Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Samarbejdspartnere
Samarbejdspartnere
Efterforskere
Efterforskere
- Ledende efterforsker: Adam DeVore, MD, MHS, Duke University
- Ledende efterforsker: Gavin Hickey, MD, University of Pittsburgh
- Ledende efterforsker: Manreet Kanwar, MD, University of Chicago
Datoer for undersøgelser
Studer store datoer
Studiestart (Faktiske)
Studiestart
Primær færdiggørelse (Anslået)
Primær færdiggørelse
Studieafslutning (Anslået)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Nøgleord
Yderligere relevante MeSH-vilkår
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- INTeGRATE
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