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HFrEF Polypill in Sri Lanka RCT

2026年8月25日 更新者：Anubha Agarwal、Washington University School of Medicine

Heart Failure With Reduced Ejection Fraction Polypill in Sri Lanka: A Multi-Center Type I Hybrid Randomized Controlled Trial

The aim of this study is to evaluate, in adults with HFrEF in Sri Lanka, the effects of an HFrEF polypill implementation strategy on the composite rate of cardiovascular disease mortality and recurrent heart failure hospitalizations, compared with usual care over a minimum of 12-months of follow-up.

Primary outcome of the study:

1) Composite rate of cardiovascular disease mortality and recurrent heart failure hospitalizations over study duration

Secondary outcomes of the study:

  1. Rate of cardiovascular disease mortality over study duration
  2. Rate of recurrent heart failure hospitalizations over the study duration
  3. Rate of all-cause mortality over the study duration
  4. Change in left ventricular ejection fraction at 12-months and end of study assessed by transthoracic echocardiogram
  5. Change in BNP levels at 12 months and end of study
  6. Change in overall and domain specific health-related quality of life at 12-months and end of study assessed by a translated validated version of the Kansas City Cardiomyopathy Questionnaire (KCCQ-23)
  7. Change in physician-reported New York Heart Association class at 12-months and end of study
  8. Adherence to guideline-directed medical therapy assessed by pill count and MARS-5 questionnaire at baseline, 1-, 6-, 12-months, and end of study. Persistence assessed as continuation of assigned therapy at each follow-up visit. Dose optimization assessed as proportion achieving target doses (Strength 3 of the polypill, or comparable individual GDMT doses in the comparator arm) at 6-, 12-months, and end of study.

Safety outcomes:

  1. Proportion of participants with serious adverse events according to Good Clinical Practice guidelines over study duration
  2. Proportion of participants with adverse events of special interest over study duration
  3. Proportion of participants with adverse events leading to HF drug discontinuation over study duration
  4. Mean change from baseline to 12-months and end of study in serum potassium (mEq/L)
  5. Mean change from baseline to 12-months and end of study in serum creatinine (mg/dL)

Participants will be randomly assigned 1:1 stratified by sex and site to one of two groups, intervention (experimental arm) or usual care (control arm). The intervention group will be given four guideline-recommended medications for heart failure with reduced ejection fraction, combined in one over-encapsulated pill, with three dose strength options. Both groups will be observed over a minimum of 12-months of follow-up to assess key outcomes.

研究概览

地位

招聘中

条件

干预/治疗

详细说明

The study intervention will be a heart failure with reduced ejection fraction (HFrEF) polypill consisting of bisoprolol (beta-blocker), losartan (ARB), eplerenone (MRA), and dapagliflozin (SGLT2i) manufactured using the over-encapsulation method and will undergo extensive stability testing to ensure quality. There will be 3 strengths of the HFrEF polypill available to facilitate initiation with low dose to prioritize clinical tolerability and laboratory safety and titration to higher doses of the HFrEF polypill. The dose of initiation and titration will be at the investigator's discretion. The HFrEF polypill will be delivered by licensed physicians responsible for managing heart failure at participating sites. Eligible providers must have formal medical qualifications in Sri Lanka and be actively involved in the care of patients with HFrEF. This includes cardiologists, internists, or general practitioners with experience in heart failure management. All participating physicians will receive standardized training on the study protocol including titration protocol, HFrEF polypill composition, and guidance for patient counseling prior to trial initiation to ensure consistent and accurate delivery of the intervention. Participants receiving the HFrEF polypill will also receive a "HFrEF polypill card" that delineates the drugs and doses included in the HFrEF polypill combination and contact information for the local study team in case of hospitalization at another facility.

HFrEF polypill combinations by strength:

HFrEF polypill strength 1: bisoprolol 2.5 mg + losartan 25 mg + eplerenone 25 mg + dapagliflozin 10 mg HFrEF polypill strength 2: bisoprolol 5 mg + losartan 50 mg + eplerenone 25 mg + dapagliflozin 10 mg HFrEF polypill strength 3: bisoprolol 10 mg + losartan 100 + eplerenone 50 mg + dapagliflozin 10 mg

Participants in the comparator control group will receive usual care from their healthcare providers. Providers will be encouraged to treat all participants according to international and local clinical practice guidelines. Participants in the intervention group will be provided with the HFrEF polypill by the study, and participants in the control group will be provided HFrEF medications through the pharmacy at the public hospital site(s) in Sri Lanka where they are generally free of cost.

研究类型

介入性

注册 (估计的)

1672

阶段

  • 第三阶段

联系人和位置

本节提供了进行研究的人员的详细联系信息，以及有关进行该研究的地点的信息。

学习联系方式

  • 姓名：Anubha Agarwal, MD MSc
  • 电话号码：+1 314-362-1291
  • 邮箱：anubha@wustl.edu

研究联系人备份

  • 姓名：Asita de Silva, MBBS DPhil FRCP
  • 电话号码：+94 11 2961241
  • 邮箱：asita@kln.ac.lk

学习地点

  • 斯里兰卡
    • Central Province
      • Kandy、Central Province、斯里兰卡、20000
        • 招聘中
        • National Hospital Kandy
        • 接触：
        • 副研究员：
          • Zanoona Siddeek
    • North Western Province
      • Kurunegala、North Western Province、斯里兰卡、60000
        • 尚未招聘
        • Teaching Hospital Kurunegala
        • 接触：
        • 副研究员：
          • Aruna Jayawarna
    • Northern Province
      • Jaffna、Northern Province、斯里兰卡、40000
        • 招聘中
        • Teaching Hospital Jaffna
        • 接触：
        • 副研究员：
          • Thepana Sasiharan
        • 副研究员：
          • Sebastian Heavenly
    • Ratnapura
      • Colombo、Ratnapura、斯里兰卡、70000
        • 尚未招聘
        • Rathnapura Teaching Hospital
        • 接触：
    • Southern Province
      • Galle、Southern Province、斯里兰卡、80000
        • 招聘中
        • National Hospital Galle
        • 接触：
        • 副研究员：
          • Piumi Rajawardhana
        • 副研究员：
          • T.G Sandamali
    • Western Province
      • Colombo、Western Province、斯里兰卡、00100
        • 尚未招聘
        • National Hospital of Sri Lanka
        • 接触：
        • 副研究员：
          • Chandrike Ponnamperuma
        • 副研究员：
          • Thisal Semina
        • 副研究员：
          • Tanya Pereira
        • 副研究员：
          • Neranja Weerakoon
        • 副研究员：
          • Chandana Wijesingha
        • 副研究员：
          • Bhathiya Ranasinghe
      • Colombo、Western Province、斯里兰卡、10290
        • 尚未招聘
        • University Hospital - General Sir John Kotelawala Defence University
        • 接触：
        • 副研究员：
          • Subash Karunarathna
        • 副研究员：
          • Sandali Wijewardena
        • 副研究员：
          • Gishara Hemachandra
        • 副研究员：
          • Sashini Amarasinghe
      • Dehiwala、Western Province、斯里兰卡、10350
        • 招聘中
        • Colombo South Teaching Hospital
        • 接触：
        • 副研究员：
          • Geethani Gunasekara
      • Gampaha、Western Province、斯里兰卡、11000
        • 尚未招聘
        • Gampaha District General Hospital
        • 接触：
      • Negombo、Western Province、斯里兰卡、11500
        • 尚未招聘
        • District General Hospital Negombo
        • 接触：
        • 副研究员：
          • Anusha de Silva
      • Ragama、Western Province、斯里兰卡、11010
        • 招聘中
        • Colombo North Teaching Hospital
        • 接触：
        • 副研究员：
          • Thushari Gunawardana
        • 副研究员：
          • Sinthi Sivarajah
        • 副研究员：
          • Anjalee Weerasuriya

参与标准

研究人员寻找符合特定描述的人，称为资格标准。这些标准的一些例子是一个人的一般健康状况或先前的治疗。

资格标准

适合学习的年龄

  • 成人
  • 年长者

接受健康志愿者

不

描述

Inclusion Criteria:

  1. Adults (≥18 years old)
  2. Diagnosis of heart failure with reduced ejection fraction (HFrEF) including clinical symptoms or clinical signs or natriuretic peptide elevation AND echocardiographic or other evidence of reduced left ventricular ejection fraction (EF ≤40%)
  3. New York Heart Association Class II, III, or IV symptoms

Exclusion Criteria:

  1. Known contraindication to any of the HFrEF polypill components (e.g., advanced renal disease, bradycardia, allergy, amongst others).
  2. Significant renal impairment (estimated glomerular filtration rate <30 mL/min/1.73 m2).
  3. Raised serum potassium >5 mEq/L.
  4. Symptomatic hypotension or systolic BP <100 mmHg as per the average of last 2 of the 3 measurements at visit 1.
  5. Symptomatic bradycardia or second or third-degree heart block without a pacemaker on ECG review at visit 1.
  6. History of type 1 diabetes mellitus.
  7. Women who are pregnant, breastfeeding or of childbearing potential and are not using and do not plan to continue using a highly acceptable form of contraception throughout the study (pharmacological or barrier methods).
  8. Concomitant illness, physical impairment or mental condition which in the opinion of the study team/ primary physician could interfere with the conduct of the study including outcome assessment.
  9. Participation in a concurrent interventional medical investigation or pharmacologic clinical trial. Patients in observational, natural history or epidemiological studies not involving an intervention are eligible.
  10. Participant's responsible physician believes it is not appropriate for participant to participate in the study.
  11. Inability or unwillingness to provide written informed consent.
  12. Involvement in the planning and/or conduct of the study.
  13. Unable to complete study procedures and/or plan to move out of the study site area in the next 12 months.

学习计划

本节提供研究计划的详细信息，包括研究的设计方式和研究的衡量标准。

研究是如何设计的？

设计细节

  • 主要用途：治疗
  • 分配：随机化
  • 介入模型：并行分配
  • 屏蔽：单身的

武器和干预

参与者组/臂
干预/治疗
有源比较器：Usual Care
Participants in the comparator control group will receive usual care from their healthcare providers. Providers will be encouraged to treat all participants according to international and local clinical practice guidelines. Participants will receive their HFrEF medications through the pharmacy at the sites, where guideline-directed medical therapy are dispensed without charge to participants when available on the public hospital formulary.
其他：Usual Care
Participants in the comparator control group will receive usual care from their healthcare providers. Providers will be encouraged to treat all participants according to international and local clinical practice guidelines. Participants will receive their HFrEF medications through the pharmacy at the sites, where guideline-directed medical therapy are dispensed without charge to participants when available on the public hospital formulary.
实验性的：HFrEF Polypill

The study intervention is a HFrEF polypill consisting of bisoprolol (beta-blocker), losartan (ARB), eplerenone (MRA), and dapagliflozin (SGLT2i) manufactured using the over-encapsulation method. There will be 3 strengths of the HFrEF polypill available:

Strength 1: bisoprolol 2.5 mg + losartan 25 mg + eplerenone 25 mg + dapagliflozin 10 mg Strength 2: bisoprolol 5 mg + losartan 50 mg + eplerenone 25 mg + dapagliflozin 10 mg Strength 3: bisoprolol 10 mg + losartan 100 mg + eplerenone 50 mg + dapagliflozin 10 mg

Every intervention participant will be established on the highest tolerated strength of the HFrEF polypill, with Strength 3 as the target dose. Following initiation at the strength matched to the participant's background guideline-directed medical therapy, the polypill strength will be advanced by one level at each scheduled study visit aligned with the initiation and titration protocol.
药品：HFrEF Polypill
The study intervention is a HFrEF polypill consisting of bisoprolol (beta-blocker), losartan (ARB), eplerenone (MRA), and dapagliflozin (SGLT2i) manufactured using the over-encapsulation method. There will be 3 strengths of the HFrEF polypill available: Strength 1: bisoprolol 2.5 mg + losartan 25 mg + eplerenone 25 mg + dapagliflozin 10 mg Strength 2: bisoprolol 5 mg + losartan 50 mg + eplerenone 25 mg + dapagliflozin 10 mg Strength 3: bisoprolol 10 mg + losartan 100 mg + eplerenone 50 mg + dapagliflozin 10 mg.

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
Composite rate of cardiovascular disease mortality and recurrent heart failure hospitalizations over study duration
大体时间：1 month, 3 month, 6 month, 9 month, 12 month study visits, and every 3 months thereafter through study completion, an average of 18 months.

Cardiovascular disease mortality is defined as death due to acute myocardial infarction, worsening heart failure, stroke, sudden cardiac death, arrhythmia, pulmonary embolism, cardiovascular procedures or their complications, other vascular causes, or any death of unknown cause unless a non-cardiovascular etiology is clearly established.

HF hospitalization is defined as any unplanned hospitalization for at least 24 hours, for which the primary cause is heart failure, accompanied by objective evidence of decompensation and requiring initiation or intensification of HF-specific therapy, occurring after a documented period of clinical stability of at least 12 hours since the prior HF event.

Adjudicated by the blinded Outcome Adjudication Committee.
1 month, 3 month, 6 month, 9 month, 12 month study visits, and every 3 months thereafter through study completion, an average of 18 months.

次要结果测量

结果测量
措施说明
大体时间
Rate of cardiovascular disease mortality over study duration
大体时间：1 month, 3 month, 6 month, 9 month, 12 month study visits, and every 3 months thereafter, through study completion, an average of 18 months.

Cardiovascular disease mortality is defined as death due to acute myocardial infarction, worsening heart failure, stroke, sudden cardiac death, arrhythmia, pulmonary embolism, cardiovascular procedures or their complications, other vascular causes, or any death of unknown cause unless a non-cardiovascular etiology is clearly established.

Adjudicated by the blinded Outcome Adjudication Committee.
1 month, 3 month, 6 month, 9 month, 12 month study visits, and every 3 months thereafter, through study completion, an average of 18 months.
Rate of recurrent heart failure hospitalizations over the study duration
大体时间：1 month, 3 month, 6 month, 9 month, 12 month visit, and thereafter every 3 months, through study completion, an average of 18 months.

HF hospitalization is defined as any unplanned hospitalization for at least 24 hours, for which the primary cause is heart failure, accompanied by objective evidence of decompensation and requiring initiation or intensification of HF-specific therapy, occurring after a documented period of clinical stability of at least 12 hours since the prior HF event.

Adjudicated by the blinded Outcome Adjudication Committee.
1 month, 3 month, 6 month, 9 month, 12 month visit, and thereafter every 3 months, through study completion, an average of 18 months.
Rate of all-cause mortality over the study duration
大体时间：1 month, 3 month, 6 month, 9 month, 12 month visit, and thereafter every 3 months, through study completion, an average of 18 months.
All-cause mortality is defined as death due to any cause.
1 month, 3 month, 6 month, 9 month, 12 month visit, and thereafter every 3 months, through study completion, an average of 18 months.
Change in left ventricular ejection fraction at 12-months and end of study assessed by transthoracic echocardiogram
大体时间：Baseline, 12 months, and at study completion, an average of 18 months.
Baseline, 12 months, and at study completion, an average of 18 months.
Change in BNP levels at 12 months and end of study
大体时间：Baseline, 12 months, and at study completion, an average of 18 months.
Baseline, 12 months, and at study completion, an average of 18 months.
Change in overall and domain specific health-related quality of life at 12-months and end of study
大体时间：Baseline, 12 months, and at study completion, an average of 18 months.
Health-related quality of life (HRQoL) will be assessed by a translated validated Kansas City Cardiomyopathy Questionnaire-23 (KCCQ-23)
Baseline, 12 months, and at study completion, an average of 18 months.
Change in physician-reported New York Heart Association class at 12-months and end of study
大体时间：Baseline, 12 months, and at study completion, an average of 18 months.
Baseline, 12 months, and at study completion, an average of 18 months.
Adherence to guideline-directed medical therapy, persistence and dose optimization
大体时间：Baseline, 1, 6, 12 months, and at study completion, an average of 18 months

Adherence to guideline-directed medical therapy assessed by pill count and MARS-5 questionnaire.

Persistence assessed as continuation of assigned therapy at each follow-up visit.

Dose optimization assessed as proportion achieving target doses (Strength 3 of the polypill, or comparable individual GDMT doses in the comparator arm) at 6-, 12-months, and end of study.
Baseline, 1, 6, 12 months, and at study completion, an average of 18 months

其他结果措施

结果测量
措施说明
大体时间
Proportion of participants with serious adverse events according to Good Clinical Practice guidelines over study duration
大体时间：1 month, 3 month, 6 month, 9 month, 12 month visit, and thereafter every 3 months, through study completion, an average of 18 months.
Proportion of participants with serious adverse events according to Good Clinical Practice (GCP) guidelines (ICH E6 [R3]) over the study duration.
1 month, 3 month, 6 month, 9 month, 12 month visit, and thereafter every 3 months, through study completion, an average of 18 months.
Proportion of participants with adverse events of special interest over study duration
大体时间：1 month, 3 month, 6 month, 9 month, 12 month visit, and thereafter every 3 months, through study completion, an average of 18 months.

Adverse events of special interest:

  1. symptomatic hypotension
  2. diabetic ketoacidosis
  3. severe hypoglycemia
  4. lower limb amputation
  5. hyperkalemia
  6. worsening renal function
  7. falls
1 month, 3 month, 6 month, 9 month, 12 month visit, and thereafter every 3 months, through study completion, an average of 18 months.
Proportion of participants with adverse events leading to HF drug discontinuation over study duration
大体时间：1 month, 3 month, 6 month, 9 month, 12 month visit, and thereafter every 3 months, through study completion, an average of 18 months.
1 month, 3 month, 6 month, 9 month, 12 month visit, and thereafter every 3 months, through study completion, an average of 18 months.
Mean change from baseline to 12-months and end of study in serum potassium (mEq/L)
大体时间：Baseline, 1 month, 3 months, 6 months, 9 months, 12 months, and at study completion, an average of 18 months.
Baseline, 1 month, 3 months, 6 months, 9 months, 12 months, and at study completion, an average of 18 months.
Mean change from baseline to 12-months and end of study in serum creatinine (mg/dL)
大体时间：Baseline, 1 month, 3 months, 6 months, 9 months, 12 months, and at study completion, an average of 18 months.
Baseline, 1 month, 3 months, 6 months, 9 months, 12 months, and at study completion, an average of 18 months.

合作者和调查者

在这里您可以找到参与这项研究的人员和组织。

赞助

Washington University School of Medicine

合作者

National Heart, Lung, and Blood Institute (NHLBI)
Centre for Chronic Disease Control, India
University of Kelaniya
The George Institute
RemediumOne

出版物和有用的链接

负责输入研究信息的人员自愿提供这些出版物。这些可能与研究有关。

有用的网址

研究记录日期

这些日期跟踪向 ClinicalTrials.gov 提交研究记录和摘要结果的进度。研究记录和报告的结果由国家医学图书馆 (NLM) 审查，以确保它们在发布到公共网站之前符合特定的质量控制标准。

研究主要日期

学习开始 (实际的)

2026年8月17日

初级完成 (估计的)

2029年4月1日

研究完成 (估计的)

2029年4月1日

研究注册日期

首次提交

2026年2月11日

首先提交符合 QC 标准的

2026年5月1日

首次发布 (实际的)

2026年5月6日

研究记录更新

最后更新发布 (实际的)

2026年8月28日

上次提交的符合 QC 标准的更新

2026年8月25日

最后验证

2026年8月1日

更多信息

与本研究相关的术语

关键字

其他相关的 MeSH 术语

其他研究编号

  • 202605087

计划个人参与者数据 (IPD)

计划共享个人参与者数据 (IPD)？

是的

IPD 计划说明

De-identified participant-level data and accompanying data dictionaries will be made available to qualified investigators upon reasonable request and following approval by the Steering Committee, consistent with NIH data-sharing policies. Requests must include a methodologically sound proposal and a data use agreement ensuring participant confidentiality.

IPD 共享时间框架

De-identified individual participant data will become available after publication of the primary results manuscript and remain available thereafter, subject to Steering Committee approval of each request.

IPD 共享访问标准

Qualified investigators may request access by submitting a methodologically sound proposal to the study Steering Committee. Approved requests require a signed data use agreement ensuring participant confidentiality, consistent with NIH data-sharing policies.

IPD 共享支持信息类型

  • 研究方案
  • 树液

药物和器械信息、研究文件

研究美国 FDA 监管的药品

不

研究美国 FDA 监管的设备产品

不

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