Multidisciplinary Approach for High-risk Patients Leading to Early Diagnosis of Canadians With Heart Failure
- Conditions
- Heart Failure
- Interventions
- Device: Us2.ai (AI-enabled report) handheld echocardiogram
- Registration Number
- NCT05860608
- Lead Sponsor
- Montreal Heart Institute
- Brief Summary
In the MAPLE-CHF trial, patients will be screened for HF risk factors using electronic medical records of participating family physicians to identify patients with potentially undiagnosed HF. Participants will then undergo a diagnostic evaluation using a blood sample for a hormone specific to the heart, the natriuretic peptide or NT-proBNP; if elevated, a portable cardiac ultrasound (ECHO) with artificial intelligence (AI) interpretation will be done; both NT-proBNP and ECHO are required for diagnosis in patients with signs and symptoms suggestive of HF. This screening ECHO coupled with AI reading from Us2.ai provides a fast, reliable, and inexpensive report, which is particularly important in our context, where waiting lists for such examinations can reach up to one year.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- WITHDRAWN
- Sex
- All
- Target Recruitment
- 1358
Male or female ≥40 years of age informed consent and at least two additional risk factors for 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 type 2, persistent or permanent atrial fibrillation, previous ischemic or embolic stroke peripheral arterial disease (previous surgical or percutaneous revascularization or documented stenosis >50% of major peripheral arterial vessel), chronic kidney disease (estimated glomerular filtration rate <60mL/min/1.73m2 or eGFR 60-90mL/min/1.73m2 and UACR >300mg/g), regular loop diuretic use for >30 days within 12 months COPD (evidenced by one of the following: PFTs showing airway obstruction diagnosis by respiratory physician CT scan reporting presence of emphysema, or treatment with national guideline COPD therapy).
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 investigators' opinion, is not suitable to participate in the trial for other reasons e.g., a diagnosis which may compromise survival over the study period.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description ACTIVE investigational arm (NT-proBNP + AI-ECHO) Us2.ai (AI-enabled report) handheld echocardiogram NT-proBNP will be performed in all individuals randomized to the ACTIVE arm at the same visit as informed consent; those with elevated NT-proBNP (≥125pg/ml) will undergo an Us2.ai (AI-enabled report) handheld echocardiogram within one month of NT-proBNP testing. A standard echocardiographic study will be performed if the AI-echo is non-diagnostic. CONTROL routine care arm Us2.ai (AI-enabled report) handheld echocardiogram Patients randomized to usual care will undergo standard clinical follow-up, with NT-proBNP and conventional echocardiography prescribed only as per usual practice.
- Primary Outcome Measures
Name Time Method Primary endpoint 6 months In both arms the diagnosis of HF will be determined by the occurrence of one or more of the following (defined in Appendix 4):
* An outpatient diagnosis of heart failure according to the ESC 2021 Heart Failure Guidelines.
* Outpatient heart failure visit.
* Urgent heart failure visit.
* Heart failure hospitalisation.
- Secondary Outcome Measures
Name Time Method Secondary endpoints 6 months Diagnosis of HFrEF within 6 months.
• Patients diagnosed with HFrEF receiving GDMT within 6 months. Guideline-directed medical therapy is defined as simultaneously receiving the 4 drugs with a Class I guideline recommendation for HFrEF (unless not tolerated or contraindicated): Angiotensin receptor neprilysin inhibitor, beta blockers, mineralocorticoid receptor antagonists, sodium-glucose cotransporter-2 inhibitors.
Trial Locations
- Locations (2)
Montreal Heart Institute
🇨🇦Montréal, Quebec, Canada
University of British Columbia
🇨🇦Vancouver, British Columbia, Canada