DANHEART (H-HeFT and Met-HeFT)

NCT ID: NCT03514108

Last Updated: 2025-12-10

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

PHASE4

Total Enrollment

1500 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-03-01

Study Completion Date

2026-12-31

Brief Summary

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The present study is testing in a combined design to types of drugs in patients with chronic heart failure: 1) Hydralazine in combination with isosorbide dinitrate (BiDil) and 2) Metformin hydrochloride. The study is double blind, placebo controlled.

1. The first hypothesis is that hydralazine in combination with isosorbide dinitrate can reduce mortality and hospitalization with worsening heart failure in chronic heart failure patients with reduced LVEF.
2. The second hypothesis is that treatment with metformin in chronic heart failure patients with reduced LVEF and type 2 diabetes / diabetes risk / insulin resistance can reduce mortality and cardiovascular hospitalizations. Among secondary endpoints are reduction in new-onset diabetes in heart failure patients with insulin resistance and diabetes risk profile and patient safety.

Detailed Description

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Conditions

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Heart Failure Diabetes

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

Patients can be allocated to either

1. both Hydralazine Isosorbide Dinitrate / Placebo and Metformin hydrochloride / Placebo
2. to only Hydralazine Isosorbide Dinitrate / Placebo.
3. to only Metformin hydrochloride / Placebo.

Patient characteristics are entered in an electronic CRF. According to in- and exclusion criteria they are randomized in three blocks:

1. Patients receiving both Hydralazine Isosorbide Dinitrate / Placebo and Metformin hydrochloride / Placebo
2. Patients receiving only Hydralazine Isosorbide Dinitrate / Placebo and
3. Patients receiving only Metformin hydrochloride / Placebo

Analysis will be performed in:

1. all patients who have received Hydralazine Isosorbide Dinitrate / Placebo (H-HeFT) and
2. all patients who have received Metformin hydrochloride / Placebo (Met-HeFT)

The study is event driven. Anticipated: both H-HeFT and Met-HeFT 900, only H-HeFT 400, only Met-HeFT 200 patients.
Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Hydralazine Isosorbide Dinitrate

Tablet BiDil (Hydralazine 37.5 mg/ isosorbide dinitrate (ISDN) 20 mg) 2 tablets x 3 daily.

Average treatment period 4 years.

Group Type ACTIVE_COMPARATOR

Hydralazine Isosorbide Dinitrate

Intervention Type DRUG

Tablet BiDil (Hydralazine 37.5 mg/ Isosorbide Dinitrate (ISDN) 20 mg) 2 tablets x 3 daily

Placebo (Hydralazine Isosorbide Dinitrate)

Tablet Placebo 2 tablets x 3 daily. Average treatment period 4 years.

Group Type PLACEBO_COMPARATOR

Placebo Oral Tablet

Intervention Type DRUG

2 tablets x 3 daily

Metformin

Tablet Metformin hydrochloride 500 mg 2 tablets x 2 daily (eGFR 35-60 ml/min: 500 mg x 2 daily). Average treatment period 4 years.

Group Type ACTIVE_COMPARATOR

Metformin Hydrochloride

Intervention Type DRUG

Tablet Metformin hydrochloride 500 mg 2 tablets x 2 daily (eGFR 35-60 ml/min: 500 mg x 2 daily)

Placebo (Metformin)

Tablet Placebo 500 mg 2 tablets x 2 daily (eGFR 35-60 ml/min: 500 mg x 2 daily). Average treatment period 4 years.

Group Type PLACEBO_COMPARATOR

Placebo Oral Tablet

Intervention Type DRUG

2 tablets x 2 daily (eGFR 35-60 ml/min: 500 mg x 2 daily)

Interventions

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Hydralazine Isosorbide Dinitrate

Tablet BiDil (Hydralazine 37.5 mg/ Isosorbide Dinitrate (ISDN) 20 mg) 2 tablets x 3 daily

Intervention Type DRUG

Placebo Oral Tablet

2 tablets x 3 daily

Intervention Type DRUG

Metformin Hydrochloride

Tablet Metformin hydrochloride 500 mg 2 tablets x 2 daily (eGFR 35-60 ml/min: 500 mg x 2 daily)

Intervention Type DRUG

Placebo Oral Tablet

2 tablets x 2 daily (eGFR 35-60 ml/min: 500 mg x 2 daily)

Intervention Type DRUG

Other Intervention Names

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BiDil

Eligibility Criteria

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Inclusion Criteria

* Patients with chronic heart failure
* NYHA-class II, III or IV
* LVEF \</= 40% within 12 months prior to screening. The echocardiography should (i) be performed after uptitration in heart failure medication and (ii) LVEF from the most recently performed echocardiographic study should be used and (iii) LVEF must not be measured during rapid atrial fibrillation, i.e. heart rate \>110/min) and (iiii) the echocardiography should be performed at least 3 months after CRT-implantation.
* Patients should be uptitrated to recommended or maximally tolerated dose of ACE-I/ARB/ARNI (unless contraindicated) and beta-blocker (unless contraindicated). If indicated, an aldosterone receptor antagonist should be given (unless contraindicated).
* A CRT device should be implanted, if indicated and accepted by the patient and patients with a CRT device should be treated for \> 3 months.
* Implantation of an ICD unit should be planned or already done, if indicated and accepted by the patient. The patient can be included in the study before a planned ICD implantation has been performed.
* Informed consent


* Systolic blood pressure ≥100 mmHg
* NT-proBNP \> 350 pg/ml or BNP \> 80 pg/ml (in patients treated with ARNI, NT-proBNP must be used)


Patients must have a diagnosis of type 2 diabetes or insulin resistance or diabetes risk. This includes 1 or more of any of the following:

* A previous diagnosis of type 2 diabetes at any time without Metformin treatment during the last 3 months
* HbA1c ≥ 5.5 % (≥ 37 mmol/mol) within 12 months prior to screening
* Fasting P-glucose ≥ 5.6 mmol/l within 12 months prior to screening (measured when the patient in stable condition / has no intercurrent illness)
* Body mass index ≥ 30 kg/m2
* If oral glucose tolerance testing (OGTT) has been performed at any time prior to randomization: 2 hour P-glucose ≥ 7.8 mmol/l
* In addition, patients in Met-HeFT must have eGFR ≥ 35 ml/min (MDRD)

Patients are randomized through an internet based randomization module. Patients can be allocated to a) both H-HeFT and Met-HeFT or to b) only H-HeFT or to c) only Met-HeFT.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Danish Heart Foundation

OTHER

Sponsor Role collaborator

Danish Council for Independent Research

OTHER

Sponsor Role collaborator

The Danish Regions: Foundation for Medical Research

UNKNOWN

Sponsor Role collaborator

The Novo Nordisk Foundation

UNKNOWN

Sponsor Role collaborator

The Aase og Ejnar Danielsen Foundation

UNKNOWN

Sponsor Role collaborator

Henrik Wiggers

OTHER

Sponsor Role lead

Responsible Party

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Henrik Wiggers

Professor, Consultant, MD, PhD, DMSc

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Henrik Wiggers, MD, PhD

Role: STUDY_CHAIR

Dept. of Cardiology, Aarhus University Hospital, Aarhus, Denmark

Lars Køber, MD, PhD

Role: STUDY_CHAIR

Dept. of Cardiology, Rigshospitalet, Copenhagen, Denmark

Finn Gustafsson, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Dept. of Cardiology, Rigshospitalet, Copenhagen, Denmark

Søren Mellemkjaer, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Dept. of Cardiology, Aarhus University Hospital, Aarhus, Denmark

Gunnar Gislason, MD, PhD

Role: STUDY_CHAIR

The Danish Heart Foundation, Copenhagen, Denmark

Locations

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Holbæk Hospital

Holbæk, Region Sjælland, Denmark

Site Status RECRUITING

Sygehus Sønderjylland, Aabenraa

Aabenraa, , Denmark

Site Status RECRUITING

Aalborg University Hospital

Aalborg, , Denmark

Site Status RECRUITING

Aarhus University Hospital

Aarhus, , Denmark

Site Status RECRUITING

Amager Hospital

Copenhagen, , Denmark

Site Status RECRUITING

Bispebjerg Hospital

Copenhagen, , Denmark

Site Status RECRUITING

Gentofte Hospital

Copenhagen, , Denmark

Site Status RECRUITING

Glostrup Hospital

Copenhagen, , Denmark

Site Status RECRUITING

Herlev Hospital

Copenhagen, , Denmark

Site Status RECRUITING

Hvidovre Hospital

Copenhagen, , Denmark

Site Status RECRUITING

Rigshospitalet

Copenhagen, , Denmark

Site Status RECRUITING

Sydvestjysk Sygehus, Esbjerg

Esbjerg, , Denmark

Site Status RECRUITING

Herning Hospital

Herning, , Denmark

Site Status RECRUITING

Nordsjællands Hospital Hillerød

Hillerød, , Denmark

Site Status RECRUITING

Regionshospital Nordjylland, Hjørring

Hjørring, , Denmark

Site Status RECRUITING

Holbæk Hospital

Holbæk, , Denmark

Site Status RECRUITING

Horsens Hospital

Horsens, , Denmark

Site Status RECRUITING

Kolding Hospital

Kolding, , Denmark

Site Status RECRUITING

Nykøbing Falster Hospital

Nykøbing Falster, , Denmark

Site Status NOT_YET_RECRUITING

Odense University Hospital

Odense, , Denmark

Site Status RECRUITING

Randers Hospital

Randers, , Denmark

Site Status RECRUITING

Sjællands Universitetshospital, Roskilde

Roskilde, , Denmark

Site Status RECRUITING

Silkeborg Hospital

Silkeborg, , Denmark

Site Status TERMINATED

Slagelse Sygehus

Slagelse, , Denmark

Site Status RECRUITING

Vejle Hospital

Vejle, , Denmark

Site Status RECRUITING

Viborg Hospital

Viborg, , Denmark

Site Status RECRUITING

Countries

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Denmark

Central Contacts

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Henrik Wiggers, MD, PhD

Role: CONTACT

+45 40136627

Facility Contacts

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Walter B Nielsen, MD

Role: primary

Bartlomiej Jonczy

Role: primary

Søren Vraa

Role: primary

Henrik Wiggers

Role: primary

+45 40136627

Jens Broennum-Schou

Role: primary

Olav Wendelbo Nielsen

Role: primary

Morten Schou

Role: primary

Jawdat Abdulla

Role: primary

Morten Schou

Role: primary

Jens Hove, MD, PhD

Role: primary

Lars Køber

Role: primary

Kirsten Vilain Mikkelsen

Role: primary

Morten Bøttcher

Role: primary

Nis Stride

Role: primary

Gitte Nielsen

Role: primary

Walter Bjørn Nielsen

Role: primary

Karen Kaae Dodt

Role: primary

Monica Petronela Poenaru

Role: primary

Lisbeth Tingsted

Role: primary

Mikael Kjær Poulsen

Role: primary

Kiomars Mahboubi

Role: primary

Niels Eske Bruun

Role: primary

Dennis Mikkelsen

Role: primary

Vibeke Brogaard

Role: primary

Malene Hollingdal

Role: primary

References

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Wiggers H, Kober L, Gislason G, Schou M, Poulsen MK, Vraa S, Nielsen OW, Bruun NE, Norrelund H, Hollingdal M, Barasa A, Bottcher M, Dodt K, Hansen VB, Nielsen G, Knudsen AS, Lomholdt J, Mikkelsen KV, Jonczy B, Bronnum-Schou J, Poenaru MP, Abdulla J, Raymond I, Mahboubi K, Sillesen K, Serup-Hansen K, Madsen JS, Kristensen SL, Larsen AH, Botker HE, Torp-Petersen C, Eiskjaer H, Moller J, Hassager C, Steffensen FH, Bibby BM, Refsgaard J, Hofsten DE, Mellemkjaer S, Gustafsson F. The DANish randomized, double-blind, placebo controlled trial in patients with chronic HEART failure (DANHEART): A 2 x 2 factorial trial of hydralazine-isosorbide dinitrate in patients with chronic heart failure (H-HeFT) and metformin in patients with chronic heart failure and diabetes or prediabetes (Met-HeFT). Am Heart J. 2021 Jan;231:137-146. doi: 10.1016/j.ahj.2020.09.020. Epub 2020 Oct 9.

Reference Type DERIVED
PMID: 33039340 (View on PubMed)

Other Identifiers

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2015-002150-12

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

DANHEART

Identifier Type: -

Identifier Source: org_study_id

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