Clinical Trial Details
— Status: Not yet recruiting
Administrative data
NCT number |
NCT05988749 |
Other study ID # |
STU-2023-0529 |
Secondary ID |
|
Status |
Not yet recruiting |
Phase |
N/A
|
First received |
|
Last updated |
|
Start date |
September 1, 2024 |
Est. completion date |
October 1, 2025 |
Study information
Verified date |
November 2023 |
Source |
University of Texas Southwestern Medical Center |
Contact |
Nicholas Hendren, MD |
Phone |
214-645-7598 |
Email |
nicholas.hendren[@]utsouthwestern.edu |
Is FDA regulated |
No |
Health authority |
|
Study type |
Interventional
|
Clinical Trial Summary
We will enroll 150 adult participants with systolic heart failure into the ADHERE-HF trial.
The study will randomize participants in a 1:2 fashion to usual care or usual care plus the
American Heart Association's Digital Solution for 90 days. This wearable device and careplan
package is hypothesized to improve rates of guideline directed heart failure medical care for
participants.
Description:
Background/Rationale:
Guideline-directed medical therapy (GDMT) is a cornerstone of the management of individuals
with heart failure with reduced ejection fraction (HFrEF). Patients on optimal heart failure
pharmacotherapy experience higher survival rates and fewer heart failure hospitalizations
compared with subjects not on these medications [1,2]. Furthermore, optimal compliance with
these treatments among patients with heart failure is associated with fewer have fewer
emergency department visits, fewer hospital admissions, shorter lengths of hospital stay, and
lower risk of death [3,4].
Despite very strong evidence for these treatments, a substantial proportion of eligible
subjects with HFrEF are not on GDMT at optimal dosages. Data from the CHAMP-HF registry
demonstrate that fewer than one in four HFrEF subjects are on all three of GDMT medications -
beta-blockers; angiotensin-converting enzyme inhibitor (ACEi)/angiotensin II receptor blocker
(ARB), or angiotensin receptor neprilysin inhibitor (ARNI); and mineralocorticoid receptor
antagonist (MRA) - and only 1% were receiving target doses of all three medications [4].
Published data for both UT-Southwestern and Parkland Health System have demonstrated that
rates of GDMT are above national averages but remain suboptimal with significant room for
improvement.
Successful interventions to increase the number of subjects of prescribed GDMT at optimal
doses often have included multidisciplinary heart failure clinics that include advanced
practice providers and/or pharmacists with frequent visits [5,6]. However, such strategies
are resource-intensive and are not widely applicable to heart failure management outside of
specialized heart failure clinics. Health systems, such as Parkland Health System and
UT-Southwestern, have also considered and purchased remote home monitoring programs for
patients with systolic heart failure to try to improve prescription rates of GDMT. However,
few studies have evaluated the impact of remote home monitoring on rates of GDMT in highly
diverse patient populations or patients with increased socioeconomic risk.
As such, there is a crucial unmet need to implement highly effective GDMT titration
strategies in heart failure populations with increased socioeconomic risk and the effects of
remote monitoring systems to improve GDMT are not well known.
To address this gap in knowledge, we will leverage the large, multiethnic heart failure
populations followed in two health systems, UT-Southwestern and Parkland Health System. Using
these racially and ethnically diverse patient populations, we will test our central
hypothesis that the AHA Digital Platform will improve outcomes in patients with HFrEF by
managing the initiation and titration of heart failure GDMT in comparison with clinical care.
The purpose of this study is to assess the effectiveness of the remote monitoring AHA Digital
Platform to improve initiation and titration of GDMT in addition to traditional clinical
encounters. The effective comparison will be to the current standard of care for heart
failure used in the respective clinical sites.
The AHA Digital platform integrates data from remote wireless vital signs collection devices
and an investigational wearable health device to recommend optimal titration of GDMT in
subjects with heart failure with reduced ejection fraction (HFrEF) subjects or HFrEF subjects
on suboptimal doses of GDMT. The platform uses a proprietary algorithm to interpret the
remote vitals data collected and presents titration recommendations back to the healthcare
provider (HCP) via a HCP mobile App for subjects randomized to the Intervention Arm at
his/her site. Vitals data and relevant HF educational materials are simultaneously presented
to the subject via a Patient App. Data from an investigational wearable health device is also
provided to both the HCP and subject, however no care decisions are made with the data from
this device. The HCP is also alerted to changes in status of the respective participating
trial subjects via the HCP App and can see aggregated information and further visualize the
status of all subjects enrolled in his/her center via an online web portal.
Hypothesis We hypothesize that use of the AHA Digital Solution in a real-world, multi-site,
randomized, outpatient study will improve rates and does of optimal Guideline-Directed
Medical Therapy (GDMT) for patients with heart failure with reduced ejection fraction.