Ultrasound-guided Treatment in Acute Heart Failure

NCT ID: NCT06181968

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

WITHDRAWN

Clinical Phase

NA

Study Classification

INTERVENTIONAL

Study Start Date

2019-03-13

Study Completion Date

2020-11-30

Brief Summary

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A randomized non-blinded study comparing ultrasound-guided therapy with conventional therapy in acute heart failure patients.

Detailed Description

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Study overview:

The purpose of this study is to evaluate whether ultrasound-guided decongestive therapy, guided by a focused thoracic ultrasound protocol combining echocardiography and lung ultrasound, could result in better decongestion and post-discharge prognosis without lengthening hospitalizations in hospitalized Acute Heart Failure patients.

Primary objectives:

To test whether ultrasound-guided therapy could result in reduced 6-month post-discharge mortality rates or re-hospitalization rates

Secondary objectives:

To test whether ultrassound-guided therapy could result in greater decongestion as defined by various congestion parameters, i.e. ultrasound-derived cardiac filling pressures on echocardiography, pulmonary congestion on lung ultrasound, reduction in natriuretic peptides and symptoms, fluid loss etc, and if this can be done without an increase in adverse events or and increase in length of hospitalizations.

Study Design and population:

ECHO-AHF is a non-blinded, randomized trial which will be conducted in 3-5 centers across Europe. Patients entering the ED between 8 am and 5 pm, monday to friady, and who fulfill study criteria will be enrolled and randomized in a 1:1-fashion

Inclusion criteria will consist of: Age 18 years or older and dyspnea at rest or orthophnea, BNP \>400ng/l or a BNP \>100ng/l AND signs of elevated LVEDP on echocardiography and multiple bilateral B-lines on LUS,. Dyspnea on excertion will not be sufficient for enrolment.

Exclusion criteria will consist of: Pulmonary fibrosis, Mental confusion, Chronic dialysis, Pregnancy/breastfeeding, Prisoners, Patient under involuntary treatment, Decision on study participation not made within 6 hours after receiving information regarding the study.

Estimated population size based on power calculation will be approximately 120 patients in total.

Investigational therapy in the treatment group:

Patients randomized to the treatment arm will receive ultrasound-guided therapy based on a focused ultrasound exam done on a daily basis except for saturdays and sundays, and their treatment will be intensified according to a pre-specified, guideline-based treatment protocol, if the daily ultrasound protocol finds them congestive. Patients in the control arm will receive guideline-based conventional decongestive therapy.

Conditions

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Acute Heart Failure Congestion

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Randomized controlled, blinded
Primary Study Purpose

PREVENTION

Blinding Strategy

TRIPLE

Participants Investigators Outcome Assessors
Only the treating physician on the ward will know which arm the patient belongs to

Study Groups

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Treatment arm

Congestive therapy will be guided by findings on daily cardiac- and lung ultrasound

Group Type ACTIVE_COMPARATOR

Cardiothoracic ultrasound protocol

Intervention Type DIAGNOSTIC_TEST

Combined echocardiography and lung ultrasound for guiding therapy

Control Arm

This arm will have the same ultrasound exams done daily as the treatment arm, but information will not be available for the treating physician for guiding therapy

Group Type SHAM_COMPARATOR

Cardiothoracic ultrasound protocol

Intervention Type DIAGNOSTIC_TEST

Combined echocardiography and lung ultrasound for guiding therapy

Interventions

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Cardiothoracic ultrasound protocol

Combined echocardiography and lung ultrasound for guiding therapy

Intervention Type DIAGNOSTIC_TEST

Eligibility Criteria

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Inclusion Criteria

* Multiple bilateral B-lines as a sign of interstitial syndrome on lung ultrasound
* Elevated natriuretic peptide level
* Signs of elevated LVEDP on echocardiography
* Dyspnea at rest or ortophnea

Exclusion Criteria

* eGFR \<25ml/min/1.73m2 or on dialysis
* Altered mental orientation
* Intubated
* Mitral stenosis or previous mitral valve procedure
* Chronic pulmonary parenchymal disease Pregnancy/breastfeeding
* Prisoners
* Patient under involuntary treatment
* Decision on study participation not made within 6 hours after receiving information regarding the study
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Kuopio University Hospital

OTHER

Sponsor Role lead

Responsible Party

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Juha Hartikainen

Clinical Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Other Identifiers

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KUH5101120

Identifier Type: -

Identifier Source: org_study_id

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