Multidisciplinary Approach for High Risk Patients Leading to Early Diagnosis of Canadians in Heart Failure

NCT ID: NCT05859048

Last Updated: 2024-03-07

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

NA

Total Enrollment

1360 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-03-01

Study Completion Date

2029-01-01

Brief Summary

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The goal of this study is improve the screening of heart failure and identify patients early who are at risk of heart failure.

The main question\[s\] it aims to answer are:

• will an electronic health records (EHR) case finding algorithm for heart failure, followed by N-Terminal pro-brain natriuretic peptide (NT-proBNP) screening and artificial intelligence (AI) echocardiogram compared to usual care identify patients at risk for heart failure earlier than standard of care?

Participants will be enrolled and randomized to either standard of care (SOC) or intervention arm:

SOC arm: electronic health records will be reviewed over six months for assessments performed to identify heart failure.

Intervention arm: blood sample for N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) at local laboratory . For elevated NT-proBNP results (\>125pg/ml) an artificial intelligence (AI) echocardiogram and 12 lead electrocardiogram (ECG) will be performed at study site (within 28 days of NT-proBNP result). EHR will be reviewed at six months

Detailed Description

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Heart failure describes a chronic condition where the heart muscle is no longer able to supply the body with enough oxygen and nutrients. This can lead to fatigue and poor quality of life. Often, people do not know they have heart failure until they end up in hospital. This study wants to improve the screening of heart failure and identify patients at risk for heart failure earlier. This will help determine if early-screening and treatment can help prevent further decline in these patients.

This is a randomized, un-blinded study comparing usual care to an intervention group receiving early heart failure testing. Pre-screening will be performed using extracted primary care electronic health records with the case finding algorithm based on the inclusion and exclusion criteria. An invitation letter will be send to prospective patients which include a registration telephone number and link to dedicated study website. The invitation for contact will adopt an "opt out" approach (ask the potential participant to contact the coordinating centre if they do not wish to be contacted).

Potential participants not opting out, or opting in, within 2 weeks of invitation mailing will be sent a patient information package along with follow up contact by research team.

Consented participants will be randomized either to usual care or interventions group and followed for six months. Intervention group will have NT-proBNP drawn and those with an elevated NT-proBNP (\>125pg/mL) will have a study visit with assessments to include, physical examination, electrocardiogram and study AI echocardiogram.

Conditions

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Heart Failure

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

SCREENING

Blinding Strategy

NONE

Study Groups

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Investigational arm guided by NT-proBNP result

NT-proBNP drawn and if level elevated (\>125 pg/ml) a study visit with artificial intelligence (AI) echocardiogram, electrocardiogram (ECG), and heart failure (HF) focused examination conducted

Group Type ACTIVE_COMPARATOR

NT-proBNP

Intervention Type DIAGNOSTIC_TEST

blood sample to measure N-terminal prohormone of B-type natriuretic peptide at local laboratory

AI echocardiogram

Intervention Type DIAGNOSTIC_TEST

Artificial intelligence driven transthoracic echocardiogram

electrocardiogram

Intervention Type DIAGNOSTIC_TEST

tracing of electrical cardiac activity of the heart

Cardiovascular physical examination

Intervention Type OTHER

basic physiological measurements to include height (cm), weight (kg) and hip circumference (cm) and blood pressure (mmHg)

Routine care arm

Participants will be remotely monitored for number of heart failure events

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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NT-proBNP

blood sample to measure N-terminal prohormone of B-type natriuretic peptide at local laboratory

Intervention Type DIAGNOSTIC_TEST

AI echocardiogram

Artificial intelligence driven transthoracic echocardiogram

Intervention Type DIAGNOSTIC_TEST

electrocardiogram

tracing of electrical cardiac activity of the heart

Intervention Type DIAGNOSTIC_TEST

Cardiovascular physical examination

basic physiological measurements to include height (cm), weight (kg) and hip circumference (cm) and blood pressure (mmHg)

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Male or female \> 40 years of age
* Informed consent
* At least two additional risk factors for Heart Failure (HF):

* Coronary artery disease (either a previous documented type 1 myocardial infarction or coronary artery bypass grafting or percutaneous coronary intervention or documented stenosis or an epicardial coronary artery (50% left main stem or \>70% left anterior descending, circumflex or right coronary artery)).
* Diabetes type 1 or 2.
* Persistent or permanent atrial fibrillation.
* Previous ischemic or embolic stroke.
* Peripheral artery disease (previous surgical or percutaneous revascularization or documented stenosis \>50% of major peripheral arterial vessel.
* Chronic kidney disease (defined as an estimated glomerular filtration rate (eGFR)\<60 milliliters per minute (mL/min)/1.73m2 or eGFR 60-90 mL/min/1.73m2 and urine albumin-creatinine ration (UACR) \>300mg/g).
* Regular loop diuretic use for \>30 days within 12 months prior to consent.
* Chronic obstructive pulmonary disease (COPD) evidenced by one of the following: Pulmonary Function Test (PFT) showing airway obstruction, diagnosis of respiratory physician, CT scan reporting presence of emphysema, or treatment with national guidance advocated COPD therapy.

Exclusion Criteria

* Inability to give informed consent (e.g. due to significant cognitive impairment).
* Previous diagnosis of heart failure. This is any diagnosis of heart failure with any ejection fraction of any cause.
* Renal replacement therapy.
* Anyone who, in the investigator's opinion, is not suitable to participate in the trial for other reasons e.g., a diagnosis which may compromise survival over the study period.
Minimum Eligible Age

40 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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AstraZeneca

INDUSTRY

Sponsor Role collaborator

Centre for Cardiovascular Innovation

UNKNOWN

Sponsor Role collaborator

NHS Greater Glasgow & Clyde

UNKNOWN

Sponsor Role collaborator

HeartLife Foundation

UNKNOWN

Sponsor Role collaborator

Canadian Heart Function Alliance

UNKNOWN

Sponsor Role collaborator

Montreal Heart Institute

OTHER

Sponsor Role collaborator

Cardiology Research UBC

OTHER

Sponsor Role lead

Responsible Party

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Nathaniel Hawkins

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Nathaniel M Hawkins, MD

Role: PRINCIPAL_INVESTIGATOR

Associate Professor of Medicine, UBC Division of Cardiology

Anique Ducharme, MD

Role: PRINCIPAL_INVESTIGATOR

Professor of Medicine, Univeriste de Montreal, Montreal Heart Institute

Serge LePage, MD

Role: PRINCIPAL_INVESTIGATOR

Centre Hospitalier Universite de Sherbrooke-Hopital Fleurimont

Locations

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Vancouver General Hospital

Vancouver, British Columbia, Canada

Site Status RECRUITING

Montreal Heart Institute

Montreal, Quebec, Canada

Site Status NOT_YET_RECRUITING

University of Sherbrooke

Sherbrooke, Quebec, Canada

Site Status NOT_YET_RECRUITING

Countries

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Canada

Central Contacts

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Naomi Uchida, BSN

Role: CONTACT

16048754521

Jennifer Petterson

Role: CONTACT

604-875-5104

Facility Contacts

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Nathaniel Hawkins, MD

Role: primary

604-875-5264

Anique Ducharme, MD

Role: primary

514-376-3330 ext. 3927

Serge LePage, MD

Role: primary

819-349-1788

Other Identifiers

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MAPLE-CHF

Identifier Type: -

Identifier Source: org_study_id

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