Dietary Sodium Intake and Outcomes in Heart Failure (PROHIBITSodium)
Rationale and Design of the PRevent Adverse Outcomes in Heart faIlure By limITing Sodium Study
研究概览
详细说明
Despite the intense research for improving outcomes in heart failure, evidence remains scarce (and mostly observational) for dietary sodium restriction, arguably the most widely recommended self-care measure for heart failure. In explicit acknowledgement of the evidence gaps and unclear benefits, the recent European Society of Cardiology guidelines have not assigned a level of evidence to sodium intake recommendations and the American College of Cardiology (ACC) and American Heart Association (AHA) guidelines do not provide a specific target level of sodium intake for patients with HF.
Although it seems reasonable to restrict sodium below <3000 mg/d in heart failure, it is currently unknown how "low" is appropriate for these patients.
This study will attempt to provide the basis to evaluate the above guidelines by determining, in consecutive HFrEF patients with EF ≤40% during an acute HF admission, the proportion of patients who: (1) are willing to participate in a 12-week feeding trial; (2) meet the trial eligibility criteria; and (C) subsequently continue to consume ≥3000 mg/d sodium 15-30 days post discharge despite discharge instructions. This will allow the investigators to estimate enrollment rates in a full-scale trial.
This study will randomize 50 eligible patients to prepared meal plans with either 1500 mg/d vs. 3000 mg/d sodium for 12 weeks .
The hypotheses of the present study are that (1) ≥ 90% of patients will be retained on the study by 12 weeks (or at first outcome or safety event) and (2) patients will be compliant with provided food ≥ 90% of the study days.
Study Primary Endpoints:
(i) Overall on-study retention and (ii) compliance with the prepared food, assessed via daily food diaries and 24-h urine collections at baseline, 4, 8, and 12 weeks.
Study Secondary Endpoints:
Estimate trends in (1) all-cause mortality, readmissions, and emergency room visits; (2) NT-pro-B-type natriuretic peptide levels; and (3) diet palatability and quality of life, between the two arms.
Safety endpoints:
Safety of the intervention assessed by vital sign and laboratory assessments. This pilot study is expected to yield critical information necessary and sufficient to design a full-scale clinical trial that will provide evidence for dietary sodium recommendations in heart failure.
研究类型
注册 (实际的)
阶段
- 不适用
联系人和位置
学习地点
-
-
New York
-
Stony Brook、New York、美国、11794
- Stony Brook University
-
-
参与标准
资格标准
适合学习的年龄
接受健康志愿者
有资格学习的性别
描述
Inclusion Criteria:
- Age ≥21 years at screening
- Recent (≤1 year) EF ≤40%
- Standard HF treatment, including ACEI/ARB & beta-blockers & aldosterone antagonists, unless contraindicated or intolerant
5. Able to consume research diet (e.g. no dysphagia etc.) 6. Systolic blood pressure ≥100 mmHg 7. >3000 mg/d sodium excretion (by 24-hr urinary sodium)
Exclusion Criteria:
- Institutionalized patients
- Siogns or symptoms of instability in HF status
- Communication barriers, including cognitive impairment; inability to communicate and understand and cooperate with the protocol
- Severe non-cardiac illness that compromises life expectancy within the next 12 months or the ability to participate in the study (e.g. severe hepatobiliary disease, cancer underground chemo- or radiotherapy)
- Any medical or surgical procedure planned in the next 6 months
- Participants planning to move to a different state within 6 months
- Participation in any other experimental protocol
- Renal replacement therapy or Stage 4 or 5 chronic kidney disease
学习计划
研究是如何设计的?
设计细节
- 主要用途:预防
- 分配:随机化
- 介入模型:并行分配
- 屏蔽:三倍
武器和干预
参与者组/臂 |
干预/治疗 |
---|---|
有源比较器:A: 1.5 gr of Sodium
Meal Plans with 1.5 gr of Sodium
|
Dietary plan with 1.5 gr vs 3 gr of Sodium
|
有源比较器:B: 3 gr of Sodium
Meal Plans with 3 gr of Sodium
|
Dietary plan with 1.5 gr vs 3 gr of Sodium
|
研究衡量的是什么?
主要结果指标
结果测量 |
措施说明 |
大体时间 |
---|---|---|
Patient On-Study Retention
大体时间:3 month meal plan
|
Percentage of patients retained in the study
|
3 month meal plan
|
次要结果测量
结果测量 |
措施说明 |
大体时间 |
---|---|---|
All cause mortality
大体时间:6 months follow up period
|
Percentage of patients died
|
6 months follow up period
|
Rehospitalization
大体时间:6 months follow up period
|
Percentage of patients rehospitalized
|
6 months follow up period
|
Emergency room visits
大体时间:6 months follow up period
|
Percentage of patients visited emergency room
|
6 months follow up period
|
NT-proBNP
大体时间:6months follow up period
|
Concentration in pg/ml
|
6months follow up period
|
Kansas City Cardiomyopathy Questionnaire
大体时间:6 months follow up period
|
The 23-item Kansas City Cardiomyopathy Questionnaire (KCCQ) measures health status in patients with heart failure (HF), KCCQ has 6 domains and 2 summary scores: Symptom Domain: frequency and burden of symptoms. Physical Function Domain: limitations. Quality of Life (QoL) Domain: reflects QoL Social Limitation Domain: ability to interact in social activities. Self-efficacy Domain: patients' perceptions of how to prevent HF exacerbations. Symptom Stability Domain: recent changes in symptoms. Clinical Summary Score includes total symptom and physical function. Overall Summary Score includes the total symptom, physical function, social limitations and QoL scores. The KCCQ is scored by assigning each response an ordinal value, beginning with 1. Scale scores are transformed to a 0 to 100 range by subtracting the lowest possible scale score, dividing by the range of the scale and multiplying by 100. Best is 100. |
6 months follow up period
|
Food Palatability Questionnaire
大体时间:6 months follow up period
|
Likert Scales for appearance, taste, and quantity of food (from 1 to 5 - 5 being the most acceptable)
|
6 months follow up period
|
其他结果措施
结果测量 |
措施说明 |
大体时间 |
---|---|---|
Systolic Blood Pressure
大体时间:6 month follow up
|
'mmHg'
|
6 month follow up
|
Creatinine
大体时间:6 month follow up
|
'mg/dl'
|
6 month follow up
|
Blood Urea Nitrogen
大体时间:6 month follow up
|
'mg/dl'
|
6 month follow up
|
合作者和调查者
调查人员
- 首席研究员:Javed Butler, MD, MPH, MBA、Stony Brook University
出版物和有用的链接
研究记录日期
研究主要日期
学习开始 (实际的)
初级完成 (实际的)
研究完成 (实际的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (估计)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
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