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Anemia in Heart Failure With a Preserved Ejection Fraction (HFPEF)

Primary Purpose

Anemia

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Erythropoietin alpha
Placebo
Sponsored by
Mathew S. Maurer
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Anemia focused on measuring Heart Failure, Elderly, Diastolic Dysfunction, Anemia, Ventricular End Diastolic Volume, Aged

Eligibility Criteria

55 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Heart failure and a preserved ejection fraction (HFPEF) - EF >=40% Anemia - defined as hemoglobin < 12 g/dL Age >= 55 years Patients must be able to understand and sign the informed consent document after the nature of the study has been fully explained, prior to beginning any study procedures. Exclusion Criteria: Presence of uncontrolled hypertension (Systolic blood pressure > 160 mm Hg and/or diastolic blood pressure > 90 mm Hg) Resting heart rate > 120 bpm Baseline 6-minute walk test > 450 meters Valvular heart disease (e.g. more than mild regurgitant or stenotic mitral, aortic, tricuspid, or pulmonic valve disease). Infiltrative cardiac disease such as hemochromatosis and amyloidosis Hypertrophic cardiomyopathy Chronic pulmonary disease (FEV 1 < 60% predicted) Renal failure (GFR < 15 ml/min) Hemoglobin < 8 g/dL BMI > 40 Exercise limited by angina, claudication, orthopedic, or neurological diseases. Severe liver dysfunction that is defined by an international normalized ratio > 2.0, not caused by an anticoagulant. Current or recent treatment (within past 6 months) with erythropoietin Erythropoietin level > 100 mU/ml Recent cardiac surgery (< 3 months) Known iron deficiency anemia from chronic GI blood loss, uterine bleeding, or other chronic bleeding Planned surgery during the course of the study Significant alcohol use or illicit drug use. Patients with a known hypercoagulable state. Active hematologic disease (e.g. sickle cell anemia, thalassemia, chronic myelogenous leukemia) or malignancy Patients with current seizure disorder or activity Patients who are known to be pregnant History of deep venous thrombosis (DVT) or pulmonary embolus (PE) within 12 months before study entry. Prior superficial thrombophlebitis is not an exclusion criterion. History of cerebrovascular accident (CVA) within 6 months History of transient ischemic attack (TIA) within 6 months History of acute coronary syndrome (ACS), or other arterial thrombosis within 6 months before study entry. ACS includes unstable angina, Q wave myocardial infarction (QwMI), and non-Q wave myocardial infarction (NQMI). Allergy or sensitivity to human serum albumin Known hypersensitivity to mammalian cell-derived products

Sites / Locations

  • Clinical Cardiovascular Research Laboratory for the Elderly

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Erythropoietin alpha

Placebo

Arm Description

Subcutaneous erythropoietin will be administered once weekly to achieve a target hemoglobin of 13 g/dL. Subjects will be dosed with the study drug for 24 weeks. The administration of study drug will be performed according to a pre-specified treatment algorithm that adjust erythropoietin dosages based on the rate of rise of the hemoglobin.

Placebo consists of saline injections.

Outcomes

Primary Outcome Measures

Change in Left Ventricular End-diastolic Volume
This outcome measure is collected using a three dimensional echocardiography.

Secondary Outcome Measures

Full Information

First Posted
February 1, 2006
Last Updated
January 30, 2017
Sponsor
Mathew S. Maurer
Collaborators
National Institute on Aging (NIA)
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1. Study Identification

Unique Protocol Identification Number
NCT00286182
Brief Title
Anemia in Heart Failure With a Preserved Ejection Fraction (HFPEF)
Official Title
Efficacy of Treating Anemia in Heart Failure With a Preserved Ejection Fraction (HFPEF) on Ventricular Function, Exercise Capacity and Health Status
Study Type
Interventional

2. Study Status

Record Verification Date
January 2017
Overall Recruitment Status
Completed
Study Start Date
July 2007 (undefined)
Primary Completion Date
November 2012 (Actual)
Study Completion Date
November 2012 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Mathew S. Maurer
Collaborators
National Institute on Aging (NIA)

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to determine if treating anemia with subcutaneous erythropoetin in patients with heart failure and a preserved ejection fraction (HFPEF) will be associated with reverse ventricular remodeling, significant improvements in exercise capacity, and improved health status, as compared with placebo.
Detailed Description
Heart failure frequently occurs in patients with a preserved ejection fraction (HFPEF) and affected subjects are predominantly elderly women with several co-morbid conditions. Despite the diversity of underlying clinical pathologies and co-morbid conditions present in these patients, a common pathophysiologic explanation is generally applied to explain their clinical symptoms. Our preliminary data show that a significant subgroup with HFPEF has increases in ventricular volumes and expanded plasma volumes, consistent with a volume overloaded state. In the setting of a preserved EF with end diastolic volume increased, stroke volume must increase, indicating a high output state. Anemia may be an important, modifiable contributor to the observed high output and volume overload as well as exercise intolerance in elderly HFPEF patients, abnormal ventricular remodeling and impaired overall health status and quality of life. This protocol evaluates the impact of treating anemia in subjects with HFPEF. The specific aims of the current study are to provide a comprehensive and mechanistically based assessment of how correcting anemia in subjects with HFPEF can impact on functional capacity, ventricular structure and function and overall health status. We propose to perform a randomized, prospective, double blind study in 80 subjects with HFPEF to test the hypothesis that the administration of subcutaneous erythropoietin will be associated with reverse ventricular remodeling, significant improvements in exercise capacity and improved health status.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Anemia
Keywords
Heart Failure, Elderly, Diastolic Dysfunction, Anemia, Ventricular End Diastolic Volume, Aged

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantOutcomes Assessor
Allocation
Randomized
Enrollment
56 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Erythropoietin alpha
Arm Type
Experimental
Arm Description
Subcutaneous erythropoietin will be administered once weekly to achieve a target hemoglobin of 13 g/dL. Subjects will be dosed with the study drug for 24 weeks. The administration of study drug will be performed according to a pre-specified treatment algorithm that adjust erythropoietin dosages based on the rate of rise of the hemoglobin.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo consists of saline injections.
Intervention Type
Drug
Intervention Name(s)
Erythropoietin alpha
Other Intervention Name(s)
Erythropoietin alpha (Epogen)
Intervention Description
Erythropoietin alpha is administered weekly by subcutaneous injection using a pre-specified dosing algorithm. The dosing algorithm is designed to make adjustments based on the rate of rise (ROR) of the hemoglobin over a one week period, as well as the absolute hemoglobin value. Subjects initially received active treatment with 7,500 units of erythropoietin given weekly by subcutaneously injection. Subjects are carefully monitored (e.g. every week) to avoid rapid increases in hemoglobin/hematocrit and/or increasing blood pressure control. Dose adjustments are made if the hemoglobin rises too rapidly (greater than 0.3 g/dL) in any given weekly interval.
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Placebo
Primary Outcome Measure Information:
Title
Change in Left Ventricular End-diastolic Volume
Description
This outcome measure is collected using a three dimensional echocardiography.
Time Frame
Baseline and 6 month

10. Eligibility

Sex
All
Minimum Age & Unit of Time
55 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Heart failure and a preserved ejection fraction (HFPEF) - EF >=40% Anemia - defined as hemoglobin < 12 g/dL Age >= 55 years Patients must be able to understand and sign the informed consent document after the nature of the study has been fully explained, prior to beginning any study procedures. Exclusion Criteria: Presence of uncontrolled hypertension (Systolic blood pressure > 160 mm Hg and/or diastolic blood pressure > 90 mm Hg) Resting heart rate > 120 bpm Baseline 6-minute walk test > 450 meters Valvular heart disease (e.g. more than mild regurgitant or stenotic mitral, aortic, tricuspid, or pulmonic valve disease). Infiltrative cardiac disease such as hemochromatosis and amyloidosis Hypertrophic cardiomyopathy Chronic pulmonary disease (FEV 1 < 60% predicted) Renal failure (GFR < 15 ml/min) Hemoglobin < 8 g/dL BMI > 40 Exercise limited by angina, claudication, orthopedic, or neurological diseases. Severe liver dysfunction that is defined by an international normalized ratio > 2.0, not caused by an anticoagulant. Current or recent treatment (within past 6 months) with erythropoietin Erythropoietin level > 100 mU/ml Recent cardiac surgery (< 3 months) Known iron deficiency anemia from chronic GI blood loss, uterine bleeding, or other chronic bleeding Planned surgery during the course of the study Significant alcohol use or illicit drug use. Patients with a known hypercoagulable state. Active hematologic disease (e.g. sickle cell anemia, thalassemia, chronic myelogenous leukemia) or malignancy Patients with current seizure disorder or activity Patients who are known to be pregnant History of deep venous thrombosis (DVT) or pulmonary embolus (PE) within 12 months before study entry. Prior superficial thrombophlebitis is not an exclusion criterion. History of cerebrovascular accident (CVA) within 6 months History of transient ischemic attack (TIA) within 6 months History of acute coronary syndrome (ACS), or other arterial thrombosis within 6 months before study entry. ACS includes unstable angina, Q wave myocardial infarction (QwMI), and non-Q wave myocardial infarction (NQMI). Allergy or sensitivity to human serum albumin Known hypersensitivity to mammalian cell-derived products
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Mathew S Maurer, MD
Organizational Affiliation
Columbia University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Clinical Cardiovascular Research Laboratory for the Elderly
City
New York
State/Province
New York
ZIP/Postal Code
10034
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
Undecided
Citations:
PubMed Identifier
15812744
Citation
Maurer MS, King DL, El-Khoury Rumbarger L, Packer M, Burkhoff D. Left heart failure with a normal ejection fraction: identification of different pathophysiologic mechanisms. J Card Fail. 2005 Apr;11(3):177-87. doi: 10.1016/j.cardfail.2004.10.006.
Results Reference
background
PubMed Identifier
15081458
Citation
Brucks S, Little WC, Chao T, Rideman RL, Upadhya B, Wesley-Farrington D, Sane DC. Relation of anemia to diastolic heart failure and the effect on outcome. Am J Cardiol. 2004 Apr 15;93(8):1055-7. doi: 10.1016/j.amjcard.2003.12.062.
Results Reference
background
PubMed Identifier
12227725
Citation
Silverberg DS, Wexler D, Blum M, Tchebiner J, Sheps D, Keren G, Schwartz D, Baruch R, Yachnin T, Shaked M, Zubkov A, Steinbruch S, Iaina A. The correction of anemia in severe resistant heart failure with erythropoietin and intravenous iron prevents the progression of both the heart and the renal failure and markedly reduces hospitalization. Clin Nephrol. 2002 Jul;58 Suppl 1:S37-45.
Results Reference
background
PubMed Identifier
11401110
Citation
Silverberg DS, Wexler D, Sheps D, Blum M, Keren G, Baruch R, Schwartz D, Yachnin T, Steinbruch S, Shapira I, Laniado S, Iaina A. The effect of correction of mild anemia in severe, resistant congestive heart failure using subcutaneous erythropoietin and intravenous iron: a randomized controlled study. J Am Coll Cardiol. 2001 Jun 1;37(7):1775-80. doi: 10.1016/s0735-1097(01)01248-7.
Results Reference
background
PubMed Identifier
12538431
Citation
Mancini DM, Katz SD, Lang CC, LaManca J, Hudaihed A, Androne AS. Effect of erythropoietin on exercise capacity in patients with moderate to severe chronic heart failure. Circulation. 2003 Jan 21;107(2):294-9. doi: 10.1161/01.cir.0000044914.42696.6a.
Results Reference
background
PubMed Identifier
15093880
Citation
Klapholz M, Maurer M, Lowe AM, Messineo F, Meisner JS, Mitchell J, Kalman J, Phillips RA, Steingart R, Brown EJ Jr, Berkowitz R, Moskowitz R, Soni A, Mancini D, Bijou R, Sehhat K, Varshneya N, Kukin M, Katz SD, Sleeper LA, Le Jemtel TH; New York Heart Failure Consortium. Hospitalization for heart failure in the presence of a normal left ventricular ejection fraction: results of the New York Heart Failure Registry. J Am Coll Cardiol. 2004 Apr 21;43(8):1432-8. doi: 10.1016/j.jacc.2003.11.040.
Results Reference
background
PubMed Identifier
23517485
Citation
Green P, Babu BA, Teruya S, Helmke S, Prince M, Maurer MS. Impact of epoetin alfa on left ventricular structure, function, and pressure volume relations as assessed by cardiac magnetic resonance: the heart failure preserved ejection fraction (HFPEF) anemia trial. Congest Heart Fail. 2013 Jul-Aug;19(4):172-9. doi: 10.1111/chf.12027. Epub 2013 Mar 20.
Results Reference
derived
PubMed Identifier
23258574
Citation
Maurer MS, Teruya S, Chakraborty B, Helmke S, Mancini D. Treating anemia in older adults with heart failure with a preserved ejection fraction with epoetin alfa: single-blind randomized clinical trial of safety and efficacy. Circ Heart Fail. 2013 Mar;6(2):254-63. doi: 10.1161/CIRCHEARTFAILURE.112.969717. Epub 2012 Dec 20.
Results Reference
derived
PubMed Identifier
21884028
Citation
Altincatal A, Macarthur RB, Teruya S, Helmke S, Maurer MS. A dosing algorithm for erythropoietin alpha in older adults with heart failure and a preserved ejection fraction. Cardiovasc Ther. 2013 Apr;31(2):92-9. doi: 10.1111/j.1755-5922.2011.00295.x. Epub 2011 Aug 26.
Results Reference
derived

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Anemia in Heart Failure With a Preserved Ejection Fraction (HFPEF)

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