Randomized, Double-Blind, Placebo Controlled Study of the Short Term Clinical Effects of Tolvaptan in Patients Hospitalized for Worsening Heart Failure With Challenging Volume Management
- Conditions
- Heart Failure
- Interventions
- Drug: placebo or sugar pill
- Registration Number
- NCT01584557
- Lead Sponsor
- Cardiovascular Clinical Science Foundation
- Brief Summary
The purpose of this study is to evaluate the short term efficacy and safety of tolvaptan in subjects hospitalized for worsening heart failure who have volume overload and one of the following: renal insufficiency, or hyponatremia or inadequate response to diuretic therapy. The primary variable for assessing efficacy will be self-assessed 7-point dyspnea score at 8 and 16 hours.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 250
-
Subjects hospitalized for worsening heart failure and randomized within 36 hours of initial presentation.
-
Males and females 18 years of age or older.
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NYHA Class III or IV on admission to the hospital.
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Able to understand content of and willing to provide written informed consent
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Dyspnea, measured by the 5-point current dyspnea scale (moderately short of breath or worse), within 2 hours of randomization and dosing.
The following must be met within 12 hours of randomization.
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The subject must have signs of extracellular volume expansion, defined as two or more of the following five: Signs of RHF ( jugular venous distention, pitting edema (≥1+), ascites) and/or Signs of LHF (pulmonary congestion on chest x-ray, pulmonary rales)
-
Have at least one of the following:
- eGFR < 60ml/min/1.73m2, OR
- serum sodium ≤ 134 mEq/L, OR
- urine output ≤ 125 ml/hr over anytime frame of at least 2 hours, following administration of IV furosemide of at least 40mg. See table below.
Time Period (hr) Cumulative UO (mL) 2 <250 3 <375 4 <500 5 <625 6 <750 7 <875 8 <1000
- Positive urine pregnancy test for women of child bearing potential.
- Inability to provide written informed consent.
- Cardiac surgery within 60 days prior to study randomization.
- Acute Coronary Syndrome (ACS) or percutaneous coronary intervention within 30 days prior to study randomization.
- Planned revascularization procedures, cardiac mechanical support implantation, cardiac transplantation, or other cardiac surgery within 30 days following study randomization.
- Planned electrophysiologic (EP) device implantation within 7 days following study randomization.
- Subjects who are on cardiac mechanical support.
- Co-morbid condition with an expected survival less than six months.
- History of a cerebrovascular accident within the last 30 days.
- Hemodynamically significant uncorrected primary cardiac valvular disease.
- Hypertrophic cardiomyopathy (obstructive or non-obstructive).
- Uncorrected thyroid disease, active myocarditis or known amyloid cardiomyopathy.
- History of primary significant liver disease or acute hepatic failure, as defined by the investigator.
- Chronic uncontrolled diabetes mellitus as determined by the investigator.
- Supine systolic arterial blood pressure < 90 mmHg.
- Serum creatinine > 3.5 mg/dL or undergoing dialysis.
- Hemoglobin < 9 g/dL
- History of hypersensitivity and/or idiosyncratic reaction to benzazepine derivatives (such as benazepril).
- Inability to take oral medications.
- Participation in another clinical drug or device trial where the last dose of drug was within the past 30 days or an investigational medical device is currently implanted.
- Previous exposure to tolvaptan within 7 days prior to randomization.
- Subjects with refractory, end-stage, heart failure defined as subjects who are appropriate candidates for specialized treatment strategies, such as ventricular assist devices, continuous positive IV inotropic therapy, or hospice care.
- Ultrafiltration within 7 days prior to randomization or planned.
- Active gout
- Serum sodium >144 mEq/L
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description sugar pill placebo or sugar pill placebo, sugar pill Tolvaptan, Samsca Tolvaptan or Samsca Tolvaptan, Samsca, uncoated tablet, 30 mg, once per day, up to 7 days.
- Primary Outcome Measures
Name Time Method To evaluate the short term efficacy and safety of tolvaptan in subjects hospitalized for worsening heart failure who have volume overload and one of the following: renal insufficiency, or hyponatremia or inadequate response to diuretic therapy. 8 and 16 hours The primary variable for assessing efficacy will be self-assessed 7-point dyspnea score at 8 and 16 hours.
- Secondary Outcome Measures
Name Time Method Change from baseline in cognitive function at 48 hours or discharge, whichever comes first at 48 hours or dischage, whichever comes first Change from baseline in cognitive function at 48 hours or discharge, whichever comes first
Change from baseline in body weight measured daily while hospitalized up to 7 days. up to 7 days Change from baseline in body weight measured daily while hospitalized up to 7 days.
Diuretic dose measured daily while hospitalized up to 7 days. up to 7 days. Diuretic dose measured daily while hospitalized up to 7 days.
Re-hospitalization for worsening heart failure or death at 30 days 30 days. Re-hospitalization for worsening heart failure or death at 30 days
Change from baseline in estimated glomerular filtration rate (eGFR) at discharge or day 7, whichever comes first. at discharge or day 7, whichever comes first. Change from baseline in estimated glomerular filtration rate (eGFR) at discharge or day 7, whichever comes first.
Days alive and out of the hospital over 30 days 30 days. Days alive and out of the hospital over 30 days
Trial Locations
- Locations (37)
The Valley Hospital
🇺🇸Ridgewood, New Jersey, United States
Drexel University College of Medicine
🇺🇸Philadelphia, Pennsylvania, United States
University of Alabama at Birmingham
🇺🇸Birmingham, Alabama, United States
Greater Los Angeles VA Medical Center
🇺🇸Los Angeles, California, United States
The Heart Center Research
🇺🇸Huntsville, Alabama, United States
MIMA Century Research Associates
🇺🇸Melbourne, Florida, United States
University of Florida Health Science Ctr. Jacksonville
🇺🇸Jacksonville, Florida, United States
University Cardiology Associates, LLC
🇺🇸Augusta, Georgia, United States
Emory University
🇺🇸Atlanta, Georgia, United States
Advocate Christ Medical Center
🇺🇸Oak Lawn, Illinois, United States
Mercer University School of Medicine
🇺🇸Macon, Georgia, United States
Advocate Medical Group - Oakbrook
🇺🇸Naperville, Illinois, United States
Louisiana Heart Center and Research
🇺🇸Slidell, Louisiana, United States
CardioSpecialists Group
🇺🇸Munster, Indiana, United States
Lahey Hospital and Medical Center
🇺🇸Burlington, Massachusetts, United States
University of Maryland
🇺🇸Baltimore, Maryland, United States
Crittenton Hospital Medical Center
🇺🇸Rochester, Michigan, United States
Tufts Medical Center
🇺🇸Boston, Massachusetts, United States
Bryan Heart Institute
🇺🇸Lincoln, Nebraska, United States
Caromont Heart/Gaston Memorial Hospital
🇺🇸Gastonia, North Carolina, United States
Duke Cardiology of Lumberton Research/Southeastern Regional Medical Cente
🇺🇸Lumberton, North Carolina, United States
Akron General Medical Center
🇺🇸Akron, Ohio, United States
The Sisters of Mercy of Hamilton, Ohio dba Mercy Hospital Fairfield
🇺🇸Fairfield, Ohio, United States
Oklahoma Heart Hospital
🇺🇸Oklahoma City, Oklahoma, United States
The Miriam Hosptial
🇺🇸Providence, Rhode Island, United States
The Heart Hospital Baylor Plano - Research Insititute
🇺🇸Plano, Texas, United States
Memorial Hospital of RI
🇺🇸Pawtucket, Rhode Island, United States
University of Texas Health Science Center
🇺🇸Houston, Texas, United States
CV Group Central Lynchburg/Stroobants Heart Center
🇺🇸Lynchburg, Virginia, United States
University of Wisconsin
🇺🇸Madison, Wisconsin, United States
Jackson Memorial Hospital
🇺🇸Miami, Florida, United States
Minneapolis Heart Institute
🇺🇸Minneapolis, Minnesota, United States
St. Vincent Medical Group
🇺🇸Indianapolis, Indiana, United States
Dayton Heart Center
🇺🇸Dayton, Ohio, United States
Ochsner Medical Center
🇺🇸New Orleans, Louisiana, United States
Advanced Cardiovascular Specialists
🇺🇸Shreveport, Louisiana, United States
University of Cincinnati
🇺🇸Cincinnatti, Ohio, United States