DANHEART (H-HeFT and Met-HeFT) (DANHEART)
Heart Failure, Diabetes
About this trial
This is an interventional treatment trial for Heart Failure focused on measuring Heart failure, Diabetes, Insulin resistance, Metformin, Hydralazine, Isosorbide Dinitrate
Eligibility Criteria
Inclusion Criteria:
General inclusion criteria for both H-HeFT and Met-HeFT
- Patients with chronic heart failure
- NYHA-class II, III or IV
- LVEF </= 40% within 12 months prior to screening. The echocardiography should (i) be performed after uptitration in heart failure medication and (ii) LVEF from the most recently performed echocardiographic study should be used and (iii) LVEF must not be measured during rapid atrial fibrillation, i.e. heart rate >110/min) and (iiii) the echocardiography should be performed at least 3 months after CRT-implantation.
- Patients should be uptitrated to recommended or maximally tolerated dose of ACE-I/ARB/ARNI (unless contraindicated) and beta-blocker (unless contraindicated). If indicated, an aldosterone receptor antagonist should be given (unless contraindicated).
- A CRT device should be implanted, if indicated and accepted by the patient and patients with a CRT device should be treated for > 3 months.
- Implantation of an ICD unit should be planned or already done, if indicated and accepted by the patient. The patient can be included in the study before a planned ICD implantation has been performed.
- Informed consent
Specific inclusion criteria for only H-HeFT:
- Systolic blood pressure ≥100 mmHg
- NT-proBNP > 350 pg/ml or BNP > 80 pg/ml (in patients treated with ARNI, NT-proBNP must be used)
Specific inclusion criteria for only Met-HeFT:
Patients must have a diagnosis of type 2 diabetes or insulin resistance or diabetes risk. This includes 1 or more of any of the following:
- A previous diagnosis of type 2 diabetes at any time without Metformin treatment during the last 3 months
- HbA1c ≥ 5.5 % (≥ 37 mmol/mol) within 12 months prior to screening
- Fasting P-glucose ≥ 5.6 mmol/l within 12 months prior to screening (measured when the patient in stable condition / has no intercurrent illness)
- Body mass index ≥ 30 kg/m2
- If oral glucose tolerance testing (OGTT) has been performed at any time prior to randomization: 2 hour P-glucose ≥ 7.8 mmol/l
- In addition, patients in Met-HeFT must have eGFR ≥ 35 ml/min (MDRD)
Patients are randomized through an internet based randomization module. Patients can be allocated to a) both H-HeFT and Met-HeFT or to b) only H-HeFT or to c) only Met-HeFT.
Sites / Locations
- Sygehus Sønderjylland, AabenraaRecruiting
- Aalborg University HospitalRecruiting
- Aarhus University HospitalRecruiting
- Amager HospitalRecruiting
- Bispebjerg HospitalRecruiting
- Gentofte HospitalRecruiting
- Glostrup HospitalRecruiting
- Herlev HospitalRecruiting
- Hvidovre HospitalRecruiting
- RigshospitaletRecruiting
- Sydvestjysk Sygehus, EsbjergRecruiting
- Herning HospitalRecruiting
- Nordsjællands Hospital HillerødRecruiting
- Regionshospital Nordjylland, HjørringRecruiting
- Holbæk HospitalRecruiting
- Horsens HospitalRecruiting
- Kolding HospitalRecruiting
- Nykøbing Falster Hospital
- Odense University HospitalRecruiting
- Randers HospitalRecruiting
- Sjællands Universitetshospital, RoskildeRecruiting
- Silkeborg Hospital
- Slagelse SygehusRecruiting
- Vejle HospitalRecruiting
- Viborg HospitalRecruiting
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm 4
Active Comparator
Placebo Comparator
Active Comparator
Placebo Comparator
Hydralazine Isosorbide Dinitrate
Placebo (Hydralazine Isosorbide Dinitrate)
Metformin
Placebo (Metformin)
Tablet BiDil (Hydralazine 37.5 mg/ isosorbide dinitrate (ISDN) 20 mg) 2 tablets x 3 daily. Average treatment period 4 years.
Tablet Placebo 2 tablets x 3 daily. Average treatment period 4 years.
Tablet Metformin hydrochloride 500 mg 2 tablets x 2 daily (eGFR 35-60 ml/min: 500 mg x 2 daily). Average treatment period 4 years.
Tablet Placebo 500 mg 2 tablets x 2 daily (eGFR 35-60 ml/min: 500 mg x 2 daily). Average treatment period 4 years.