Thoracentesis to Alleviate Cardiac Pleural Effusion
- Conditions
- Heart FailurePleural Effusion
- Interventions
- Drug: Standard-of-care medical treatmentProcedure: Thoracentesis
- Registration Number
- NCT05017753
- Lead Sponsor
- Bispebjerg Hospital
- Brief Summary
The present study will examine the comparative effectiveness of two treatment strategies currently used in the treatment of patients with systolic heart failure presenting with pleural effusion. Patients will be randomized to standard medical treatment only or medical treatment and referral to thoracentesis.
Study hypothesis: A strategy of referring patients with heart failure-related pleural effusion to thoracentesis increases number of days alive outside of hospital over the following 90 days.
- Detailed Description
Purpose and Rationale: Pleural effusion is a common presentation in patients with heart failure, and the condition is related to a poor prognosis and increased mortality. Therapeutic options consist of intensification of diuretic treatment and invasive drainage of the effusion (thoracentesis). Thoracentesis is a common medical procedure and is often performed on patients with heart failure presenting with a pleural effusion, but there is no randomized evidence to guide the use of thoracentesis in heart failure-related pleural effusion. International guidelines provide no recommendations. Some Danish hospitals use thoracentesis frequently, some rarely. Hence, there is true clinical equipoise and a strong need to assess whether thoracentesis benefits patients or not.
Study Hypothesis: A strategy of referring patients with heart failure-related pleural effusion to thoracentesis increases number of days alive outside of hospital over the following 90 days.
Study Setting:126 adult patients admitted with systolic heart failure and pleural effusion documented by either chest x- ray, ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) will be randomized 1:1 to medical treatment only or medical treatment and referral to thoracentesis. Thoracentesis will be performed according to local practice. Randomization will be stratified according to whether patients are treated with oral anticoagulation.
Crossover/rescue thoracentesis: For patients in the medical treatment arm whose condition deteriorates to the degree that the participant fulfill any of the study exclusion criteria (eg. increased need of oxygen), thoracentesis may be performed immediately. Some patients randomized to medical treatment only may prove to be too diuretic resistant to achieve an adequate effect of medical treatment alone. The recommended waiting period before performing thoracentesis on a patient in the control group is 5 days from randomization.
Patients may be discharged at the discretion of the treating physician. The follow up period is planned to 90 days.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 135
- Left ventricular ejection fraction (LVEF) ≤ 45%
- Non- negligible pleural effusion by x-ray, ultrasound, CT or MRI, suspected to be due to heart failure
- Age ≥ 18 years
- Clinically indicated diagnostic thoracentesis (e.g. suspected malignant aetiology)
- Suspected pulmonary or pleural infection (pneumonia symptoms with c- reactive protein>100 mg/L or white blood count>11)
- Recent (<3 months) intrathoracic procedure (including heart or lung surgery, transcatheter aortic valve implantation (TAVI) or thoracentesis)
- Contraindications to thoracentesis according to local guidelines (such as spontaneously elevated international normalized ratio (INR) or thrombocytopenia), patients on oral anticoagulation may be randomized.
- Severe aortic stenosis
- Massive pleural effusion (equivalent to >2/3 of lung on a standing chest x-ray)
- Substantially affected hemodynamics (systolic blood pressure < 85mmHg, need of inotropes) or high oxygen demand (>7L/min)
- Estimated glomerular filtration rate (eGFR) <15ml/min/1.73m2 or dialysis treatment
- Planned or expected admission > 10 days for other condition than heart failure
- Inability to give informed consent
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Control group Standard-of-care medical treatment Standard-of-care medical treatment. Intervention group Thoracentesis Thoracentesis in addition to standard-of-care medical treatment.
- Primary Outcome Measures
Name Time Method Days alive outside of hospital (days) 90 days Number of days the patient is alive outside of hospital in the 90 days following randomization
- Secondary Outcome Measures
Name Time Method Time to death (days) 90 days Time to first readmission or death (days) 90 days Satisfaction with hospital stay (Likert scale) Up til 1 week after discharge Selected questions from the questionnaire "Questions about your admission" from the annual Danish National Survey of Patient Experiences to assess satisfaction with index admission. Likert scale from 1-5. 5 represents the best outcome.
Kansas City Cardiomyopathy Questionnaire (KCCQ-23) (score) At 14 days and 90 days - up til 1 week Kansas City Cardiomyopathy Questionnaire (KCCQ). Selected scores from the 23-item questionnaire at 14 and 90 days. Scores from 0-100 with 100 representing the best outcome.
Complications to thoracentesis (count) From randomization until the date af discharge from hospital. Estimated time frame from 2 days to 3 weeks. Number of complications to interventional thoracentesis
Changes from baseline in weight during admission (kg) From randomization until the date af discharge from hospital. Estimated time frame from 2 days to 3 weeks. Changes in weight during admission
Complications during hospital stay (count) From randomization until the date af discharge from hospital. Estimated time frame from 2 days to 3 weeks. Number of complications during the index admission (eg. infections, delirium, falls, thrombosis)
Duration of index admission (days) From randomization until the date af discharge from hospital. Estimated time frame from 2 days to 3 weeks. Duration of index admission following randomization.
Change from baseline in dosage of diuretics during admission (mg/day) From randomization until the date af discharge from hospital. Estimated time frame from 2 days to 3 weeks. Change in dosage of diuretics during index admission
Days alive and not hospitalized due to heart failure during the 90 days following randomization. 90 days
Trial Locations
- Locations (10)
University Hospital Aarhus
🇩🇰Aarhus, Denmark
University Hospital Aalborg
🇩🇰Aalborg, Denmark
University Hospital Bispebjerg and Frederiksberg
🇩🇰Copenhagen, Denmark
University Hospital Rigshospitalet
🇩🇰Copenhagen, Denmark
University Hospital Herlev/Gentofte
🇩🇰Herlev, Denmark
University Hospital Rigshospitalet, Glostrup
🇩🇰Glostrup, Denmark
University Hospital Nordsjaelland
🇩🇰Hillerød, Denmark
University Hospital Hvidovre
🇩🇰Hvidovre, Denmark
University Hospital Zealand, Roskilde
🇩🇰Roskilde, Denmark
University Hospital Odense
🇩🇰Odense, Denmark