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Study of Heart Failure Hospitalizations After Aquapheresis Therapy Compared to Intravenous (IV) Diuretic Treatment (AVOID-HF)

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ClinicalTrials.gov Identifier: NCT01474200
Recruitment Status : Terminated (Closed due to patient recruitment challenges. No interim analyses were completed; study closure was not related to any concerns about safety or futility.)
First Posted : November 18, 2011
Results First Posted : October 12, 2015
Last Update Posted : May 10, 2017
Sponsor:
Collaborators:
Gambro UF Solutions, Inc.
Gambro Renal Products, Inc.
Information provided by (Responsible Party):
Baxter Healthcare Corporation

Study Description
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Brief Summary:
The purpose of the research is to determine if patients have fewer Heart Failure (HF) events after receiving Aquapheresis (AQ) therapy compared to intravenous (IV) diuretics up to 90 days of discharge from the hospital. Heart Failure events are defined as returning to the hospital, clinic or emergency department (ED) for treatment of HF symptoms.

Condition or disease Intervention/treatment Phase
Heart Failure Cardiac Failure Acute Decompensated Heart Failure (ADHF) Device: Isolated veno-venous ultrafiltration (AQ) Drug: IV Loop Diuretics (LD) Not Applicable

Detailed Description:
The aim of the proposed AVOID-HF study is to confirm and expand the findings that fluid removal by AQ reduces HF rehospitalizations at 90 days as well as the length of these HF rehospitalizations. In the "Ultrafiltration Versus Intravenous Diuretics for Patients Hospitalized for Acute Decompensated Heart Failure" (UNLOAD) study, the 90 day HF re-hospitalizations were pre-specified secondary end-points. AVOID-HF is designed with a primary end-point to determine if AQ reduces the number of HF events (Rehospitalization or unscheduled outpatient or emergency room treatment for HF) after discharge from index hospitalization compared to IV loop diuretics. AVOID will also explore days alive and out of the hospital as a secondary end-point, which was not done in UNLOAD. In other words, the AVOID-HF study is going beyond studying only the amount of fluid removal and will explore whether the modality of fluid removal influences HF outcomes.
Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 224 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Aquapheresis Versus Intravenous Diuretics and Hospitalizations for Heart Failure (AVOID-HF)
Study Start Date : January 2012
Actual Primary Completion Date : July 2014
Actual Study Completion Date : July 2014

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Heart Failure

Arms and Interventions
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Arm Intervention/treatment
Experimental: Aquapheresis (AQ) - isolated veno-venous ultrafiltration
Excess fluid from the patient is removed by isolated veno-venous ultrafiltration treatment using the Aquadex Flex Flow System
 Device: Isolated veno-venous ultrafiltration (AQ)
Aquapheresis treatment (isolated veno-venous ultrafiltration) using the Aquadex FlexFlow System during index hospitalization until the patient's signs and symptoms of fluid overload have improved to the satisfaction of the treating physician. Ultrafiltration rates, duration and frequency of treatment are dependent on the amount of patient fluid excess and on the rate of fluid movement from the interstitial spaces into the vascular compartment during Aquapheresis (Plasma Refill Rate, or PRR)
Other Names:
  • Aquapheresis
  • Ultrafiltration
  • Aquadex FlexFlow System
  • Gambro UF Solutions
Active Comparator: IV Loop Diuretics (LD)
Excess fluid from the patient is removed by IV (Intravenous) loop diuretic treatment
 Drug: IV Loop Diuretics (LD)
IV Loop Diuretics treatment using only FDA approved IV loop diuretics indicated for the treatment of patients with fluid overload. This includes furosemide or other IV loop diuretics administered at equivalent doses to furosemide. Patients will receive either a twice daily IV bolus or continuous IV LD infusions according to the high dose protocol of the"Diuretic strategies in patients wth acute decompensated heart failure" (DOSE) trial.
Other Name: furosemide


Outcome Measures
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Primary Outcome Measures :
  1. Time to First Heart Failure (HF) Event [ Time Frame: 90 days after discharge from index HF hospitalization. ]

    Time to first HF event within 90 days after discharge from index HF hospitalization. HF events are defined as

    • HF rehospitalization or
    • unscheduled outpatient or emergency room treatment with IV loop diuretics or
    • unscheduled outpatient Aquapheresis treatment


Secondary Outcome Measures :
  1. EFFICACY: Total Fluid Removed During the Index Hospitalization [ Time Frame: Index Hospitalization, an average of 8 days ]
    AQ-Fluid removed by AQ plus urine voided versus urine voided when treated with IV diuretics

  2. EFFICACY: Net Fluid Removed During the Index Hospitalization [ Time Frame: Index Hospitalization, an average of 8 days ]
    AQ-Fluid removed by AQ plus urine voided minus fluid intake versus urine voided minus fluid intake with the IV diuretics.

  3. EFFICACY: Weight Loss at 72 Hours After Initiation of Treatment [ Time Frame: 72 hours after treatment initiation ]
    Weight at 72 hours after treatment initiation minus weight at treatment initiation. Negative mean values indicate weight loss.

  4. EFFICACY: Total Weight Loss During the Index Hospitalization [ Time Frame: Index Hospitalization, an average of 8 days ]
    Weight at hospital discharge minus weight at hospital admission. Negative mean values indicate weight loss.

  5. EFFICACY: Time to Freedom From Congestion [ Time Frame: Index Hospitalization, an average of 8 days ]
    Time from hospital admission to time patient is free of congestion in the hospital. Freedom from congestion is defined as jugular venous distention of < or equal to 8 cm, with no orthopnea and with trace peripheral edema or no edema. Measurement taken every 24 hours after treatment initiation.

  6. EFFICACY: Freedom From Congestion [ Time Frame: Index Hospitalization, an average of 8 days ]
    Defined as jugular venous distention of < or equal to 8 cm, with no orthopnea, and with trace peripheral edema or no edema at hospital discharge

  7. EFFICACY: Changes in B-type Natriuretic Peptide (BNP) Levels Over Time [ Time Frame: Baseline and at 72 hours from baseline, hospital discharge and at 90 days after hospital discharge ]
    Change in BNP levels over time at 72 hours, discharge, and 90 days after discharge.

  8. CLINICAL: Length of Stay (LOS) During the Index Hospitalization [ Time Frame: Index hospitalization admission to index hospitalization discharge ]
    Number of days patient is in hospital for HF treatment.

  9. CLINICAL: Total Number of Days Rehospitalized for Heart Failure (HF) at 30 and 90 Days After Discharge [ Time Frame: Within 30 days and 90 days after hospital discharge ]
    Days rehospitalized for HF symptoms requiring hospital, emergency room or clinic treatment involving the use of IV diuretics and /or positive inotropic or vasodilator drugs.

  10. CLINICAL: Total Number of Emergency Department (ED) or Unscheduled Office Visits at 30 and 90 Days After Discharge [ Time Frame: Within 30 days and 90 days after hospital discharge ]
    Number of visits for HF symptoms requiring ED or clinic treatment involving the use of IV diuretics and /or positive inotropic or vasodilator drugs

  11. CLINICAL: Total Number of Heart Failure (HF) Rehospitalizations at 30 and 90 Days After Discharge [ Time Frame: Within 30 days and 90 days after hospital discharge ]
    Number of different times patient was admitted to hospital for HF symptoms within 90 days of index hospitalization discharge.

  12. CLINICAL: Total Number of Cardiovascular (CV) Rehospitalizations at 30 and 90 Days After Discharge [ Time Frame: Within 30 days and 90 days after hospital discharge ]
    CV symptoms that required hospitalization for treatment within 90 days of index hospitalization discharge.

  13. CLINICAL: Total Number of Days for Cardiovascular (CV) Rehospitalizations at 30 and 90 Days After Discharge [ Time Frame: Within 30 days and 90 days after hospital discharge ]
    The total number of days spent in the hospital due to CV related events at 30 days and 90 days from hospital discharge.

  14. CLINICAL: All Cause Rehospitalization Rates at 30 and 90 Days [ Time Frame: Within 30 days and 90 days after hospital discharge ]
    Any cause that required hospitalization for treatment within 90 days of index hospitalization discharge.

  15. CLINICAL: Mortality Rates Within Index Hospitalization or Within 90 Days After Hospital Discharge. [ Time Frame: Time from randomization to 90 days post-hospital discharge ]
    Death due to any cause.

  16. CLINICAL: Days Alive and Out of Hospital at 30 and 90 Days After Discharge [ Time Frame: Within 30 and 90 days after hospital discharge ]
    Number of days patients were alive and out of the hospital.

  17. CLINICAL: Quality of Life Assessed Using the Kansas City Cardiomyopathy Questionnaire (KCCQ) at 30, 60 and 90 Days After Discharge [ Time Frame: Within 90 days after hospital discharge ]
    Questionnaire assessed patients quality of life prior to index treatment versus timeframes following hospital discharge. Scores were transformed to a range of 0-100, in which higher scores reflect better health status.

  18. CLINICAL: Global Clinical Score at 30 and 90 Days After Discharge [ Time Frame: Within 90 days after hospital discharge ]
    KCCQ Questionnaire analysis based on patient's self-assessment of how they feel at various intervals compared to how they felt prior to index treatment. Scores were transformed to a range of 0-100, in which higher scores reflect better health status.

  19. SAFETY: Changes in Renal Function (Serum Creatinine) After Treatment up to 90 Days After Randomization [ Time Frame: Within 90 days of randomization ]
    Changes in renal function prior to index treatment compared to various intervals by assessing the patient's serum creatinine (sCr), Blood Urea Nitrogen(BUN), BUN/sCr ratio and estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD) formula

  20. SAFETY: Changes in Renal Function (Blood Urea Nitrogen) After Treatment up to 90 Days After Randomization [ Time Frame: Within 90 days of randomization ]
    Changes in renal function prior to index treatment compared to various intervals by assessing the patient's serum creatinine (sCr), Blood Urea Nitrogen(BUN), BUN/sCr ratio and estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD) formula

  21. SAFETY: Changes in Renal Function (Blood Urea Nitrogen/Serum Creatinine) After Treatment up to 90 Days After Randomization [ Time Frame: Within 90 days of randomization ]
    Changes in renal function prior to index treatment compared to various intervals by assessing the patient's serum creatinine (sCr), Blood Urea Nitrogen(BUN), BUN/sCr ratio and estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD) formula

  22. SAFETY: Changes in Renal Function (Estimated Glomerular Filtration Rate) After Treatment up to 90 Days After Randomization [ Time Frame: Within 90 days of randomization ]
    Changes in renal function prior to index treatment compared to various intervals by assessing the patient's serum creatinine (sCr), Blood Urea Nitrogen(BUN), BUN/sCr ratio and estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD) formula


Eligibility Criteria
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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. 18 years of age or older
  2. Male or non-pregnant female patients
  3. Admitted to the hospital with a primary diagnosis of acute decompensated heart failure (ADHF)
  4. On regularly scheduled oral loop diuretics prior to admission

  5. Fluid overload manifested by at least two of the following:

    1. Pitting edema (2+) of the lower extremities
    2. Jugular venous distention > 8 cm
    3. Pulmonary edema or pleural effusion on chest x-ray
    4. Paroxysmal nocturnal dyspnea or ≥ two- pillow orthopnea
    5. Respiration rate ≥ 20 per minute.
  6. Have received ≤ 2 IV loop diuretics doses before randomization
  7. Must be able to be enrolled into the trial ≤ 24 hours of their admission to the hospital.
  8. Provide written informed consent form as required by the local IRB (Institutional Review Board)

Exclusion Criteria:

  1. Acute coronary syndromes
  2. Renal insufficiency with a sCr ≥ 3.0 mg/dl or planned renal replacement therapies
  3. Systolic blood pressure < 90 mmHg at time of enrollment
  4. Pulmonary Arterial Hypertension not secondary to left heart disease
  5. Contraindications to systemic anticoagulation
  6. Hematocrit > 45%
  7. Inability to obtain venous access
  8. Hemodynamic instability severe enough to require IV positive inotropic agents, IV vasodilators or both
  9. Use of iodinated radiocontrast material within the previous 72 hours or planned study requiring IV contrast during the current hospitalization
  10. Severe concomitant disease expected to prolong hospitalization
  11. Severe concomitant disease expected to cause death in ≤ 90 days
  12. Sepsis or ongoing systemic infection
  13. Severe uncorrected valvular stenosis
  14. Active myocarditis
  15. Hypertrophic obstructive cardiomyopathy
  16. Constrictive pericarditis or restrictive cardiomyopathy
  17. Liver cirrhosis
  18. Previous solid organ transplant
  19. Requirement for mechanical ventilatory support
  20. Presence of a mechanical circulatory support device
  21. Unwillingness or inability to complete follow up
  22. Active drug or ETOH substance abuse
  23. Participating in another interventional clinical trial
Contacts and Locations
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Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01474200


Locations
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Sponsors and Collaborators
Baxter Healthcare Corporation
Gambro UF Solutions, Inc.
Gambro Renal Products, Inc.
Investigators
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Principal Investigator: Maria Rosa Costanzo, MD Midwest Heart Foundation
More Information
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Publications:

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Responsible Party: Baxter Healthcare Corporation
ClinicalTrials.gov Identifier: NCT01474200    
Other Study ID Numbers: Gambro 1494
First Posted: November 18, 2011    Key Record Dates
Results First Posted: October 12, 2015
Last Update Posted: May 10, 2017
Last Verified: April 2017
Keywords provided by Baxter Healthcare Corporation:
Ultrafiltration
Aquapheresis
Diuretics
 Loop Diuretics
Aquadex Flexflow System
Gambro UF Solutions
Additional relevant MeSH terms:
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Heart Failure
Heart Diseases
Cardiovascular Diseases
Furosemide
Diuretics
 Sodium Potassium Chloride Symporter Inhibitors
Natriuretic Agents
Physiological Effects of Drugs
Membrane Transport Modulators
Molecular Mechanisms of Pharmacological Action