Digoxin Short Term Treatment Assessment Randomized Trial in AHF

NCT ID: NCT02544815

Last Updated: 2023-12-18

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

PHASE3

Total Enrollment

500 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-05-01

Study Completion Date

2025-07-31

Brief Summary

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AHFS management is challenging and most of the used drugs has failed to decrease post-discharge mortality and readmission rates which represent the most important goal in AHFS.

Digoxin processes many characteristics of a beneficial drug for heart failure, however recent publications has rose concerns about its safety profile and therefore decreasing its use.

Whether digoxin is efficient and safe in short term treatment of acute heart failure is a question that should be studied.

Detailed Description

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AHFS management is challenging given the heterogeniety of the patient population, absence of a universally accepted definition, incomplete understanding of its pathophysiology, and lack of evidence based guidelines.

The majority of patients appear to respond well to initial therapies consisting of loop diuretics and vasoactive agents. however, this treatments failed to decrease post-discharge mortality and readmission rates which represent the most important goal in AHFS.

In the last few years, many drugs has been tested in AHFS setting trying to adress this issue, however results has been disappointing in term of efficacy and / or safety.

Although evidence supports the beneficial effects of digoxin on hemodynamic, neurohormonal, and electrophysiological parameters in patients with CHF, recent publications has rose concerns about its safety profile and therefore decreasing its use.

The effects of digoxin alone or in combination with other vasodilators are seen within few hours of its administration and result in increased cardiac output, decreased pulmonary wedge pressure, increased ejection fraction, and improved neurohormonal profile without changes in blood pressure.

All this findings made us rose the question of whether digoxin is effective or not in short term treatment of acute heart failure ? Additionnel treatments for AHF were given according left to ACCF/AHA for the managementof heart failure .

Blood testing for scanner digoxin magerments will be confirmed at H8, h24 and H72 after the post protocol treatment admession treatment administration.

Conditions

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Acute Heart Failure

Keywords

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digoxin, eficacy, safety

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Caregivers

Study Groups

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Digoxin

Oral digoxin 0.25 mg: one pill per day for 30 consecutive days.

Group Type ACTIVE_COMPARATOR

Digoxin

Intervention Type DRUG

Digoxin 0.25 mg pills

Placebo

Oral placebo for 30 days.

Group Type PLACEBO_COMPARATOR

Placebo

Intervention Type DRUG

Placebo pills

Interventions

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Digoxin

Digoxin 0.25 mg pills

Intervention Type DRUG

Placebo

Placebo pills

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Able to provide informed written consent.
* Male or female aged ≥18 years old.
* Admitted for acute heart failure defined by the presence of dypnea at rest or with minimal exertion , pulmonary congestion on chest radiograph ; and increased natriutic peptide concentrations ( BNP \>=350 pg/ml) or NTproBNP \>=1400 pg/ml ) .
* Able to be randomized within 12 hours from presentation to the hospital.

Exclusion Criteria

* Pregnant or breast feeding women.
* Known severe or terminal renal failure.
* Previous hepatic impairment.
* Major surgery within 30 days.
* Hematocrit \< 25%.
* Alteration of consciousness GCS \< 15
* Critically ill patients needing immediate mechanical hemodynamic of ventilatory support.
* Confirmed or suspected diagnosis of ACS within 45 days before inclusion.
* Severe arrhythmias including significant sinoatrial or atrioventricular blocks or WPW syndrome.
* Implantable cardiac devices including pacemakers and defibrillators.
* Hypertrophic obstructive, restrictive, or constrictive cardiomyopathy.
* Noncardiac pulmonary edema, including suspected sepsis.
* Severe pulmonary disease
* Significant stenotic valvular disease .
* Hyperkalemia \> 5.5 mmol /L .
* Administration of an investigational drug or implantation of an investigational device or participation in another trial within 30 days before screening.
* Previous treatment with digoxin within 15 days before inclusion or contra-indications to digoxin.
* Inability to follow instructions or comply with follow-up procedures.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Monastir

OTHER

Sponsor Role lead

Responsible Party

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Pr. Semir Nouira

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Nouira Semir, Professor

Role: PRINCIPAL_INVESTIGATOR

University Hospital of Monastir

Locations

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Sahloul University Hospital

Hammam Sousse, Sousse Governorate, Tunisia

Site Status RECRUITING

Fattouma Bourguiba University Hospital

Monastir, , Tunisia

Site Status RECRUITING

Countries

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Tunisia

Central Contacts

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Nouira Semir, Professor

Role: CONTACT

Phone: 73106000

Email: [email protected]

Bzeouich Nasri, MD

Role: CONTACT

Phone: 52919170

Email: [email protected]

Facility Contacts

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Boukef Riadh, Professor

Role: primary

Nouira Semir, Professor

Role: primary

nasri Bzeouich, MD

Role: backup

References

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Gheorghiade M, Zannad F, Sopko G, Klein L, Pina IL, Konstam MA, Massie BM, Roland E, Targum S, Collins SP, Filippatos G, Tavazzi L; International Working Group on Acute Heart Failure Syndromes. Acute heart failure syndromes: current state and framework for future research. Circulation. 2005 Dec 20;112(25):3958-68. doi: 10.1161/CIRCULATIONAHA.105.590091. No abstract available.

Reference Type BACKGROUND
PMID: 16365214 (View on PubMed)

Digitalis Investigation Group. The effect of digoxin on mortality and morbidity in patients with heart failure. N Engl J Med. 1997 Feb 20;336(8):525-33. doi: 10.1056/NEJM199702203360801.

Reference Type BACKGROUND
PMID: 9036306 (View on PubMed)

Hashim T, Elbaz S, Patel K, Morgan CJ, Fonarow GC, Fleg JL, McGwin G, Cutter GR, Allman RM, Prabhu SD, Zile MR, Bourge RC, Ahmed A. Digoxin and 30-day all-cause hospital admission in older patients with chronic diastolic heart failure. Am J Med. 2014 Feb;127(2):132-9. doi: 10.1016/j.amjmed.2013.08.006. Epub 2013 Sep 23.

Reference Type BACKGROUND
PMID: 24067296 (View on PubMed)

Other Identifiers

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Digoxin - START - AHF

Identifier Type: -

Identifier Source: org_study_id