Heart Failure, Systolic Clinical Trial
Official title:
Effect of Moderate vs Severe Sodium Restriction on Brain Natriuretic Peptide in Patients With Heart Failure and Reduced Ejection Fraction
The SODA-HF trial is a randomized, double-blind, controlled trial to evaluate the effect of
moderate to severe sodium restriction on brain natriuretic peptide in patients with heart
failure and reduced ejection fraction (less than 40%).
Secondary outcomes are quality of life, NYHA functional class, glomerular filtration rate,
renin plasmatic activity, aldosterone and composite clinical outcome (all-cause mortality and
cardiovascular hospitalization)
Allocation: Those patients who meet the selection criteria will go to the nutritionist who
will make the assignment to one of the sodium restriction groups.
Generation of the sequence: patients will be assigned to the two groups based on a table of
random numbers generated by a statistical analysis program. Blocks of 10 will be used.
Mechanism of concealment of the assignment: the nutritionist will be the only person who will
know to which group the patient was assigned, the patient will not know to which group was
assigned, neither will the researcher know. The person in charge of measuring the results
will also be blinded.
Description of the intervention: the nutritionist will be the one to calculate diets
appropriate to the needs of each of the patients. Patients will be allowed a maximum intake
of 1.5 liters of water per day, including the liquid of soups, juices and drinks; This will
be explained in detail to the patients. The diets will be identical in calories according to
the weight of the patient. The only difference in diets will be the sodium content, which
will be 3 grams of sodium vs. 2 grams of sodium.
Blinding: The patients, the researcher and those responsible for measuring the results will
be blinded to the assignment of the intervention. Patients will not know which group they
have been assigned to since they will not know the sodium content of the diet nor will they
be aware of what diet the other patients were assigned to. Those responsible for conducting
laboratory studies will not know to which group the patients have been assigned.
Blinding may be opened in the event that a patient suffers a severe adverse effect.
Follow-up: After assignment of the intervention, the patients will be cited at 6, 12 and 20
weeks. In Nutriology visits, the adherence of the intervention will be evaluated by means of
a 24-hour diet reminder. According to the results obtained, the nutritionist will make
recommendations in the diet to maintain a sodium intake of 3000 or 2000 mg according to the
group to which hte patient has been assigned.
At the end of the intervention the natriuretic peptide value will be determined, as well as
plasma activity of renin, aldosterone, GFR and the composite clinical outcome (all-cause
mortality and cardiovascular hospitalization).
If a patient is hospitalized during the study, he will follow the treatment indicated by his
treating doctor. Once the patient is discharged from the hospital, he will continue with
previously scheduled follow-up appointments. If the sampling scheduled during the study
coincides with an episode of unplanned hospitalization, the patient will wait until the
patient has completed at least 4 weeks after discharge to take the corresponding samples.
If any patient dies during the study, he will be eliminated from the primary objective which
is the determination of natriuretic peptide.
Monitoring of the study. Monitoring of information: Given that the study will be conducted in
a single center, it is considered that a data monitoring committee will not be necessary.
Monitoring of patient safety: During the scheduled medical visits, a complete physical
examination will be carried out with detailed attention to the signs and symptoms of heart
failure. Weight, height, heart rate and systemic blood pressure will be measured. If a
patient presents symptoms of heart failure exacerbation, he will be taken to the emergency
department for a complete evaluation and adjustment of treatment.
According to the Mexican Official Norm 012-SSA3-2012, it will be considered adverse effect to
the set of signs and symptoms not calculated and unexpected that appear in a research
subject, and that potentially represent a risk to his health. If an adverse effect occurs, it
will be notified no later than the business day following the corresponding Research
Committee. In case of a severe adverse event (one that endangers the patient's life), the
corresponding Research Committee will be notified immediately.
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