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Clinical Trials/NCT05934487
NCT05934487
Recruiting
N/A

A Prospective, Multi-Center, Open Label, Randomized Control Clinical Trial Evaluating the Safety and Efficacy of the Cordella™ Pulmonary Artery Sensor System in New York Heart Association (NYHA) Class II-III Heart Failure Patients

Endotronix, Inc.95 sites in 3 countries1,750 target enrollmentNovember 29, 2023

Overview

Phase
N/A
Intervention
Cordella™ Pulmonary Artery Sensor System
Conditions
Not specified
Sponsor
Endotronix, Inc.
Enrollment
1750
Locations
95
Primary Endpoint
Safety- Single Arm- Freedom from pressure sensor failure
Status
Recruiting
Last Updated
3 months ago

Overview

Brief Summary

This is a prospective, multi-center, open label, randomized control clinical trial evaluating the safety and efficacy of the Cordella™ Pulmonary Artery Sensor System in NYHA Class II-III Heart Failure Patients (PROACTIVE-HF-2 Trial).

The study contains of 5 arms:

NYHA II Cohort - To demonstrate safety and efficacy of the Cordella PA Sensor System in NYHA Class II HF patients, where patients have daily access to PAP data.

  • Treatment Arm (Group 1)
  • Active Control Arm (Group 2)
  • Crossover Arm (Group 3)

NYHA III Cohort - To demonstrate safety and efficacy of the Cordella PA Sensor System in NYHA Class III HF patients, where patients have daily access to PAP data, including a randomized sub-study to evaluate a clinician-directed patient self-management strategy.

Registry
clinicaltrials.gov
Start Date
November 29, 2023
End Date
September 1, 2033
Last Updated
3 months ago
Study Type
Interventional
Study Design
Parallel
Sex
All

Investigators

Responsible Party
Sponsor

Eligibility Criteria

Inclusion Criteria

  • Subject has given written informed consent
  • Male or female, at least 18 years of age
  • Diagnosis and treatment of HF (regardless of LVEF) for ≥ 3 months and NYHA Class II HF (NYHA II Cohort) or NYHA III (NYHA III Cohort) at time of Screening
  • 4\. Subjects should be receiving appropriate medical therapy for heart failure according to current AHA/ACC guidelines as standard-of-care for HF therapy in the United States, or current ESC guidelines for HF treatment in Europe for at least 30 days prior to the Screening/Enrollment visit. Stable is defined as no more than a 100% increase or 50% decrease in dose. These criteria may be waived if a subject is intolerant of ACE-I, ARB, ARNI), MRA, beta-blockers, or SGLT2i, subject is unable to afford these agents, subject has contraindications to these agents, or these agents are not indicated under the Guidelines. Such intolerance, lack of affordability, contraindications, or lack of indications must be documented.
  • HFrEF (EF \< 50%): Subject has been on stable medications maximized to the subject's tolerance of ACE-I or ARB or ARNI, MRA, beta-blockers, and SGLT2i as determined by the study investigator for at least 30 days prior to Screening/Enrollment
  • HFpEF (EF ≥ 50%): Subject has been on stable medication maximized to the subject's tolerance of SGLT2i as determined by the study investigator for at least 30 days prior to Screening/Enrollment
  • NYHA II Cohort- HF related hospitalization within 6 months (last hospitalization should be 30 days before Screening /Enrollment)
  • NYHA III Cohort -HF related hospitalization within 12 month (last hospitalization should be 30 days before Screening/Enrollment)
  • 6\. Subjects should be on diuretic therapy (≥40 mg\] furosemide or equivalent) for ≥ 1 month at time of Screening
  • 7\. Subjects who are physically able to hold the myCordella™ Patient Reader unit (approximate weight 1.3lb) against the ventral thoracic surface for up to 2 minutes per day while in a seated position, as well as dock and undock the myCordella™ Patient Reader

Exclusion Criteria

  • ACC/AHA Stage D refractory HF (including a known history of \>24 hours of IV inotropic therapy to support circulation within the past 6 months (other than relation to a procedure))
  • Subjects with history of recurrent pulmonary embolism (≥2 episodes within 5 years prior to Screening Visit) and/or deep vein thrombosis in the femoral or IJ vein used for access (\< 3 month prior to Screening Visit)
  • Subjects with a resting systolic blood pressure \<90 mmHg and/ or severe pre-capillary pulmonary hypertension with a pulmonary artery systolic pressure of ≥70 mm/Hg with pulmonary capillary wedge pressure ≤ 15 mmHg at the Cordella PA Sensor Implant RHC (V2)
  • Subjects who have had a major cardiovascular (CV) event (e.g., myocardial infarction, stroke) within 3 months of the Screening Visit
  • Unrepaired severe valvular disease
  • Subjects with significant congenital heart disease that has not been repaired and would prevent implantation of the Cordella PA Sensor or mechanical/tissue right heart valve(s)
  • Subjects with known coagulation disorders
  • Subjects with a hypersensitivity or allergy to platelet aggregation inhibitors including aspirin, clopidogrel, prasugrel, and ticagrelor; or patients unable to take dual antiplatelet or anticoagulants for one-month post implant
  • Known history of life-threatening allergy to contrast dye.
  • Subjects whereby RHC is contraindicated

Arms & Interventions

NYHA II Treatment Arm

All subjects will receive the Cordella Sensor. Clinicians will manage the subjects to target PAP per protocols specific Treatment Guidelines and according to Guideline-Directed Medical Therapy.

Intervention: Cordella™ Pulmonary Artery Sensor System

NYHA II Active Control Arm

All subjects will receive the Cordella Sensor. Clinicians will manage subjects using the subjects daily data trends (BP, weight, HR, SpO2 symptoms) according to Guideline Directed Medical Therapy. Once the primary endpoint (24 months) is met, subjects and clinicians will be unblinded to PAP.

Intervention: Cordella™ Pulmonary Artery Sensor System

NYHA II Crossover Arm

All subjects will receive the Cordella Sensor. At least 12 months following implant and following an adjudicated HFH, subjects in the Active Control Arm can qualify to crossover to the Crossover Arm and both patients and clinicians would then be unmasked to PAP. Clinicians will then manage the subjects to target PAP per protocols specific Treatment Guidelines and according to Guideline-Directed Medical Therapy.

Intervention: Cordella™ Pulmonary Artery Sensor System

NYHA III Phase I Treatment Arm

All subjects will receive the Cordella Sensor. Clinicians will manage the subjects to target PAP per protocols specific Treatment Guidelines and according to Guideline-Directed Medical Therapy.

Intervention: Cordella™ Pulmonary Artery Sensor System

NYHA III Phase I Active Control Arm

All subjects will receive the Cordella Sensor. Clinicians will manage subjects using the subjects daily data trends (BP, weight, HR, SpO2 symptoms) according to Guideline Directed Medical Therapy. Once the primary endpoint (6 months) is met, subjects and clinicians will be unblinded to PAP.

Intervention: Cordella™ Pulmonary Artery Sensor System

NYHA III Clinician-Directed Patient Self-Management Arm (randomized)

This is Phase II / Randomization #2 following implant provided patient meets eligiibity criteria. Subjects will be instructed to take their PAP measurements daily in addition to their weight, BP, SpO2, and HR. All data, including PAP, will be visible to the patient. Subjects will manage their diuretics per protocol specific Clinician-Directed Patient Self-Management Treatment Guidelines. Clinicians will oversee the patient self-management to target PAP per protocol specific Treatment Guidelines and according to Guideline-Directed Medical Therapy.

Intervention: Cordella™ Pulmonary Artery Sensor System

NYHA III Clinician Management Arm (randomized)

This is Phase II / Randomization #2 following implant provided patient meets eligiibity criteria. Subjects will be instructed to take their PAP measurements daily in addition to their weight, BP, SpO2, and HR. All data, including PAP, will be visible to the patient. Subjects will manage their diuretics per protocol specific Clinician-Directed Patient Self-Management Treatment Guidelines. Clinicians will manage the patients to target PAP per protocols specific to Treatment Guidelines and according to Guideline Directed Medical Therapy.

Intervention: Cordella™ Pulmonary Artery Sensor System

NYHA III Clinician Management Arm (Not randomized)

Subject will not be randomized if they do not meet eligibility criteria to potentially be randomized to Clinician-Directed Patient Self-Management. Subjects will be instructed to take their PAP measurements daily in addition to their weight, BP, SpO2, and HR. All data, including PAP, will be visible to the patient. Subjects will manage their diuretics per protocol specific Clinician-Directed Patient Self-Management Treatment Guidelines. Clinicians will manage the patients to target PAP per protocols specific to Treatment Guidelines and according to Guideline Directed Medical Therapy.

Intervention: Cordella™ Pulmonary Artery Sensor System

Outcomes

Primary Outcomes

Safety- Single Arm- Freedom from pressure sensor failure

Time Frame: 12 months

Freedom from pressure sensor failure at 12 months

Efficacy- NYHA II Cohort - A composite of first HF event or death from Cardiovascular Death up to 24 months.

Time Frame: 24 months

A composite endpoint of first HF event or death from CVD up to 24 months.

Efficacy- NYHA III Cohort (Phase I) - a composite of HF events or death from cardiovascular disease at 6 months

Time Frame: 12 months

A composite of HF events or death from cardiovascular disease at 6 months

Safety- Randomized Arm- Freedom from device/system related complication

Time Frame: 24 months

Freedom from device/system related complication at 24 months

Safety- Randomized Arm-Freedom from pressure sensor failure

Time Frame: 24 months

Freedom from pressure sensor failure at 24 months

Safety- Single Arm-Freedom from device/system related complication

Time Frame: 12 months

Freedom from device/system related complication at 12 months

Efficacy- NYHA III Cohort (Phase II) - A test of non-inferiority at 12 months of the percentage of patients at or below trend seated mPAP of 25 mmHg in (i) Clinician-Directed Patient Self-Management vs. (ii) Clinician Management Arm

Time Frame: 12 months

A test of non-inferiority at 12 months of the percentage of patients at or below trend seated mPAP of 25 mmHg in (i) Clinician-Directed Patient Self-Management vs. (ii) Clinician Management Arm

Secondary Outcomes

  • Efficacy - NYHA II Cohort & NYHA III Cohort - Death from cardiovascular disease(Duration of study (to 5 years))
  • Efficacy - NYHA II Cohort & NYHA III Cohort - HF Hospitalizations(Duration of study (to 5 years))
  • Efficacy - NYHA II Cohort & NYHA III Cohort- HF Hospitalizations(12 months and 24 months)
  • Efficacy - NYHA II Cohort & NYHA III Cohort - All-cause mortality(Duration of study (to 5 years))
  • Efficacy - NYHA II Cohort & NYHA III Cohort - Urgent HF visits(Duration of study (to 5 years))
  • Efficacy - NYHA II Cohort - Incidence of HF hospitalizations or all-cause mortality(12 months)
  • Efficacy - NYHA III Cohort - Composite of first HF event (HF hospitalization or urgent HF visit or death from cardiovascular disease (CVD)(Up to 24 months)
  • Eff-NYHA II Cohort & NYHA III Cohort -time to death, # HFH or urgent HF visits, time to first HFH or urgent HF visit, diff >/= 15 KCCQ BSL to 24 mos,diff >/= 10 in KCCQ BSL to 24 mos, diff >/= 5 in KCCQ BSL to 24 mos, diff >/= 30m in 6 MWT BSL to 24 mos(Duration of study (to 5 years))
  • Efficacy - NYHA II Cohort & NYHA III Cohort - Various measurements via ECHO and evaluated by ECHO core lab at Baseline, 12, 24, 36, 48 and 60 months.(Duration of study (to 5 years))
  • Efficacy - NYHA II Cohort & NYHA III Cohort - Heart failure related medication changes(Duration of study (to 5 years))
  • Efficacy - NYHA II Cohort & NYHA III Cohort - Change in PAP from baseline(Duration of study (to 5 years))
  • Efficacy - NYHA II Cohort & NYHA III Cohort - Change in PAP from baseline as measured by echocardiogram (ECHO) and evaluated by anECHO core lab at 12, 24, 36, 48, and 60 months(Duration of study (to 5 years))
  • Efficacy - NYHA II Cohort & NYHA III Cohort - Patient Outcome Measures as measured by KCCQ, Brief Illness Perception Questionnaire, andEuroQol-5 Dimensions-5 Level (EQ-5D-5L)(Duration of study (to 5 years))
  • Efficacy - NYHA II Cohort & NYHA III Cohort - Functional status improvement as measured by NYHA classification and 6MWT(Duration of study (to 5 years))
  • Efficacy - NYHA II Cohort & NYHA III Cohort - Health Economic Analysis(Duration of study (to 5 years))
  • Efficacy - NYHA II Cohort & NYHA III Cohort - HFH stratified by ejection fraction (HFrEF, HFmrEF, HFpEF, and HF recovered EF) and baselineenrollment ECHO estimated systolic PAP(Duration of study (to 5 years))
  • Efficacy - NYHA II Cohort & NYHA III Cohort - Mortality by baseline EF (HFrEF, HFmrEF, HFpEF, HF recovered EF), and baseline enrollmentECHO estimated systolic PAP(Duration of study (to 5 years))
  • Efficacy - NYHA II Cohort & NYHA III Cohort - Days alive outside hospital (DAOH)(Duration of study (to 5 years))
  • Efficacy - NYHA II Cohort & NYHA III Cohort - Adherence to regular PAP and vital sign measurements including a sub-analysis on subjectswho move to another area of the country(Duration of study (to 5 years))
  • Safety - NYHA II Cohort - Freedom from device/system related complications at 12 months(Duration of study (to 5 years))
  • Safety - NYHA III Cohort - Freedom from pressure sensor failure at 12 months(Duration of study (to 5 years))
  • Safety - NYHA II Cohort & NYHA III Cohort - Pressure sensor failure rate throughout the study(Duration of study (to 5 years))
  • Safety - NYHA II Cohort & NYHA III Cohort - Frequency of serious adverse events throughout the study(Duration of study (to 5 years))
  • Safety - NYHA II Cohort & NYHA III Cohort - Frequency of implant procedure and procedure related adverse events and serious adverse events(Duration of study (to 5 years))
  • Safety - NYHA III Cohort - Freedom from device/system related complications at 24 months(Duration of study (to 5 years))
  • Safety - NYHA III Cohort - Freedom from pressure sensor failure at 24 months(Duration of study (to 5 years))
  • Efficacy - NYHA II Cohort & NYHA III Cohort - HF Hospitalizations(12 months, 18 months and 24 months)
  • Efficacy - NYHA II Cohort & NYHA III Cohort - HF Hospitalizations(12 month)

Study Sites (95)

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