Peripheral Venous Pressure-Guided Decongestive Therapy in Heart Failure 2
Phase: PHASE4
Conditions: Heart Failure, Congestion, Congestive Heart Failure
Sponsor: Başakşehir Çam & Sakura City Hospital

P V P- G ui d e d D e c o n g e sti v e T h er a p y i n H F 2 ( P E RI P H E R A L- H F 2)
N C T 0 6 4 9 5 8 9 2
N C T 0 6 4 9 5 8 9 2
J ul y 1, 2 0 2 4
PVP-Guided Decongestive Therapy in HF 2 
(PERIPHERAL-HF2)
NCT06495892
July 1st, 2024

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PERIPHERAL-HF
Page 1
Identification
Project ID#
__________________________________
Name and surname
__________________________________
National ID#
__________________________________
Age
__________________________________
Gender
Male
Female
Boy
(in centimeters)
__________________________________
Kilo
(the first measured weight in kilograms)
__________________________________
Recommend allowing access for physicians to e-pulse account.
(For easy access to long-term follow-up).
Phone number
(May be required for follow-up. Example; 0532 510 97
__________________________________
98, 0216 283 38 38)
Phone number #2 (if available)
(May be required for follow-up. Example; 0532 510 97
__________________________________
98, 0216 283 38 38)

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PERIPHERAL-HF
Page 2
Randomization
Center
Ankara Etlik Şehir Hastanesi
Antalya Atatürk Devlet Hastanesi
(Please select randomizing center.)
Akdeniz Üniversitesi Tıp Fakültesi
Bağcılar Eğitim ve Araştırma Hastanesi
Bakırçay Üniversitesi Tıp Fakültesi, Çiğli
Eğitim ve Araştırma Hastanesi
Başakşehir Çam ve Sakura Şehir Hastanesi
Dr. Siyami Ersek Göğüs Kalp ve Damar Cerrahisi
Eğitim Ve Araştırma Hastanesi
Eskişehir Şehir Hastanesi
Erzurum Atatürk Üniversitesi Hastanesi
İdil Devlet Hastanesi
Kafkas Üniversitesi Sağlık Araştırma ve
Uygulama Hastanesi
Kütahya Sağlık Bilimleri Üniversitesi Tıp
Fakültesi Hastanesi
Mehmet Akif Ersoy Eğitim ve Araştırma Hastanesi
Pazarcık Devlet Hastanesi
Tokat Gaziosmanpaşa Üniversitesi Tıp Fakültesi
Hastanesi
Trakya Üniversitesi Tıp Fakültesi Hastanesi
Study arm
Pressure guided
(Study arm according to randomization scheme)
Standard
Randomization date
(Select as day-month-year)
__________________________________
Has the patient been excluded?
Yes
(Has the patient been excluded after randomization ?)
No
Select the reason for exclusion.
Upper extremity venous disease
(Select the reason for exclusion if the patient has
Serum creatinine ≥ 3.5 mg/dL
been excluded after randomization.)
Severe stenotic valvular disease
Hypertrophic obstructive cardiomyopathy
Rejection or withdrawal of consent
Other
Please explain.
(Explain the reason for exclusion if the patient has
__________________________________
been excluded after randomization.)
Consent form
(You can download consent form from this link.)
[Attachment: "PERIPHERAL-HF Onam formu.pdf"]
Signed consent form
(Please upload scanned file or photo of signed consent
form. Keep the original.) 

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PERIPHERAL-HF
Project ID#
__________________________________
Hypertension
(Average blood pressure >140/90 mmHg or use of
antihypertensive medication)
Yes
No
Diabetes
(FPG>126 mg/dL for two times or HbA1c>%6.5 or use of
antidiabetic medication)
Yes
No
Dyslipidemia
(LDL>160 mg/dL or use of antihyperlipidemic drug)
Yes
No
Active smoking
(Smoking history in the last one year)
Yes
No
Chronic obstructive pulmonary disease
(Prior diagnosis of COPD or long-acting bronchodilator
use with a clinical picture consistent with COPD)
Yes
No
Chronic kidney disease
(GFR < 60 ml/min/1.73 m2 known or supposed to be
longer than 3 months)
Yes
No
Prior myocardial infarct
(Documented diagnosis or imaging evidence of an old
[>1 month] myocardial infarct) 
Yes
No
Prior percutaneous coronary intervention
(Documented history or imaging evidence of a prior
coronary intervention) 
Yes
No
Prior coronary arterial by-pass grafting
(Documented history or imaging evidence of a prior
CABG) 
Yes
No
Prior ICD/CRT implantation
(Documented history or imaging evidence of a prior
ICD/CRT implantation)  
Yes
No
History
Page 3

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PERIPHERAL-HF
Page 4
Admission Findings
Admission type
De novo heart failure
(With regard to heart failure)
Heart failure decompensation
Etiology of heart failure
Ischemic
(Respond accoerding to current or past information.)
Non-ischemic
Could not be differentiated
Systolic blood pressure on admission
(in mmHg)
__________________________________
Heart rate on admission
(in beats per minute)
__________________________________
Subjective dyspnea score
None
Rare
Frequent
Always
Subjective orthopnea score
None
Rare
Frequent
Always
Subjective fatigue score
None
Rare
Frequent
Always
Pretibial edema
None
1+
2+
3+
4+
Pulmonary rales
None
Limited to the bases
Lower half
More than lower half

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Jugular venous distention
(Compared to angle of Louis while lying at 45 degree supine position.)
Cannot be observed
Normal (< 4.5 cm)
High (>4.5 cm) but pulsations can be seen
Exceeds angulus mandibula
BUN on admission
(Just before or after admission, in mg/dL, e.g.; 12)
__________________________________
Creatinine on admission 
(Just before or after admission, in mg/dL, e.g.; 1.2)
__________________________________
Sodium on admission
(Just before or after admission, in mEq/L, e.g.; 142)
__________________________________
Potassium on admission
(Just before or after admission, in mEq/L, e.g.; 4.2)
__________________________________
Hemoglobin on admission
(Just before or after admission, in g/dL, e.g.; 12.3)
__________________________________
Hematocrit on admission
(Just before or after admission, in %, e.g.; 31)
__________________________________
Albumin on admission
(Just before or after admission, in g/dL, e.g.; 3.1)
__________________________________
Total protein on admission
(Just before or after admission, in g/dL, e.g.; 5.2)
__________________________________
BNP/NT-proPNP on admission
(Just before or after admission, in pg/mL, e.g.; 125)
__________________________________
Uric acid on admission
(Just before or after admission, in mg/dL, e.g.; 5.5)
__________________________________
Rhythm on ECG ?
Sinus
(Dominant rhythm on ECG')
AF
Other
Left bundle branch block on ECG ?
Yes
(Select according to the dominant conduction,
No
excluding pacemaker rhythm)
Ejection fraction
(in percent, example; 55)
__________________________________
Mitral regurgitation
(0=none, 1=mild, 2=moderate, 3=moderate-to-severe,
__________________________________
4=severe)

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Tricuspid regurgitation
(0=none, 1=mild, 2=moderate, 3=moderate-to-severe,
__________________________________
4=severe)
Estimated pulmonary arterial pressure
(in mmHg including estimated right atrial pressure,
__________________________________
e.g.; 50. 0 if cannot be calculated.)
Venous pressure
__________________________________
(in mmHg; e.g., 5. If the subject is in standard
therapy arm, caregiver should be blinded to this
measurement.)
Quality of waveform
Good (Clear atrial or respiratory pressure
oscillations)
(Interpret the visual quality of waveform)
Moderate (Less clear pressure oscillations but a
stable measurement with an appropriate
modified-Valsalva response)
Poor (No oscillations, increasing, no appropriate
modified-Valsalva response or nonphysiological
readings)

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PERIPHERAL-HF
Page 7
Prior Medications
Aspirin
(Used medications before admission)
Yes
No
P2Y12 inhibitor
(Used medications before admission)
Yes
No
OAC/NOAC
(Used medications before admission)
Yes
No
Beta-blocker
(Used medications before admission)
Yes
No
ACEi/ARB
(Used medications before admission)
Yes
No
ARNI
(Used medications before admission)
Yes
No
SGLT2i
(Used medications before admission)
Yes
No
MRA
(Used medications before admission)
Yes
No
Loop diuretic
(Used medications before admission)
Yes
No
Oral furosemide equivalent dose
(40 mg furosemide po=20 mg furosemide iv=20 mg
__________________________________
torasemide po)
Digoxin
(Used medications before admission)
Yes
No
Statin
(Used medications before admission)
Yes
No

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PERIPHERAL-HF
Page 8
In-hospital Course (1st day)
1st day fluid intake
__________________________________
(From admission to next day morning, in mL , e.g.;
1250) 
1st day urine output
__________________________________
(From admission to next day morning, in mL , e.g.;
1250. Do not add extra losses, such as paracentesis or
thoracentesis) 
BUN after 1st day
__________________________________
(First morning value after admission, in mg/dL , e.g.;
25) 
Creatinine after 1st day
__________________________________
(First morning value after admission, in mg/dL , e.g.;
1.5) 
Sodium after 1st day
__________________________________
(First morning value after admission, in mEq/L , e.g.;
135) 
Potassium after 1st day
__________________________________
(First morning value after admission, in mEq/L , e.g.;
4.5) 
Total intravenous furosemide equivalent of loop
diuretic dose 
__________________________________
(40 mg furosemide po=20 mg furosemide iv=20 mg
torasemide po)
Total asetozolamide dose
(0 if not used)
__________________________________
Total thiazide dose
(0 if not used)
__________________________________
Total MRA dose
(0 if not used)
__________________________________
1st day venous pressure
__________________________________
(Value in the first morning after admission, in mmHg,
e.g..; 25)

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Quality of waveform
Good (Clear atrial or respiratory pressure
oscillations)
(Interpret the visual quality of waveform)
Moderate (Less clear pressure oscillations but a
stable measurement with an appropriate
modified-Valsalva response)
Poor (No oscillations, increasing, no appropriate
modified-Valsalva response or nonphysiological
readings)
You do not need to input any data in this form as the
Yes
in-hospital follow-up is ended. Please proceed to the
No
next instrument . 
(If in-hospital follow-up continues, check the
previous form "Discharged today (or follow-up is
terminated for another reason) ? and change the answer
to "No".)

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PERIPHERAL-HF
Page 10
In-hospital Course (2nd day)
2nd day fluid intake
__________________________________
(From previous to this day morning, in mL , e.g.;
1250) 
2nd day urine output
__________________________________
(From previous to this day morning, in mL , e.g.;
1250. Do not add extra losses, such as paracentesis or
thoracentesis) 
BUN after 2nd day
__________________________________
(First morning value after admission, in mg/dL , e.g.;
25) 
Creatinine after 2nd day
__________________________________
(First morning value after admission, in mg/dL , e.g.;
1.5) 
Sodium after 2nd day
__________________________________
(First morning value after admission, in mEq/L , e.g.;
135) 
Potassium after 2nd day
__________________________________
(First morning value after admission, in mEq/L , e.g.;
4.5) 
Total intravenous furosemide equivalent of loop
diuretic dose 
__________________________________
(40 mg furosemide po=20 mg furosemide iv=20 mg
torasemide po)
Total asetozolamide dose
(0 if not used)
__________________________________
Total thiazide dose
(0 if not used)
__________________________________
Total MRA dose
(0 if not used)
__________________________________
2nd day venous pressure
__________________________________
(Value in the second morning after admission, in mmHg,
e.g..; 25)

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Page 11
Quality of waveform
Good (Clear atrial or respiratory pressure
oscillations)
(Interpret the visual quality of waveform)
Moderate (Less clear pressure oscillations but a
stable measurement with an appropriate
modified-Valsalva response)
Poor (No oscillations, increasing, no appropriate
modified-Valsalva response or nonphysiological
readings)
Discharged today (or follow-up is terminated for
Yes
another reason) ?
No
(If "Yes" these values will be accepted as
pre-discharge measurements.)
You do not need to input any data in this form as the in-hospital follow-up is ended. Please proceed to the next
instrument . 
(If in-hospital follow-up continues, check the previous form "Discharged today (or follow-up is terminated for another
reason) ? and change the answer to "No".)

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PERIPHERAL-HF
Page 12
In-hospital Course (3rd day)
3rd day fluid intake
__________________________________
(From previous to this day morning, in mL , e.g.;
1250) 
3rd day urine output
__________________________________
(From previous to this day morning, in mL , e.g.;
1250. Do not add extra losses, such as paracentesis or
thoracentesis) 
BUN after 3rd day
__________________________________
(Third morning value after admission, in mg/dL , e.g.;
25) 
Creatinine after 3rd day
__________________________________
(Third morning value after admission, in mg/dL , e.g.;
1.5) 
Sodium after 3rd day
__________________________________
(Third morning value after admission, in mEq/L , e.g.;
135) 
Potassium after 3rd day
__________________________________
(Third morning value after admission, in mEq/L , e.g.;
4.5) 
Total intravenous furosemide equivalent of loop
diuretic dose 
__________________________________
(40 mg furosemide po=20 mg furosemide iv=20 mg
torasemide po)
Total asetozolamide dose
(0 if not used)
__________________________________
Total thiazide dose
(0 if not used)
__________________________________
Total MRA dose
(0 if not used)
__________________________________
3rd day venous pressure
__________________________________
(Value in the third morning after admission, in mmHg,
e.g..; 25)

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Page 13
Quality of waveform
Good (Clear atrial or respiratory pressure
oscillations)
(Interpret the visual quality of waveform)
Moderate (Less clear pressure oscillations but a
stable measurement with an appropriate
modified-Valsalva response)
Poor (No oscillations, increasing, no appropriate
modified-Valsalva response or nonphysiological
readings)
Discharged today (or follow-up is terminated for
Yes
another reason) ?
No
(If "Yes" these values will be accepted as
pre-discharge measurements.)
You do not need to input any data in this form as the in-hospital follow-up is ended. Please proceed to the next
instrument . 
(If in-hospital follow-up continues, check the previous form "Discharged today (or follow-up is terminated for another
reason) ? and change the answer to "No".)

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PERIPHERAL-HF
Page 14
In-hospital Course (4th day)
4th day fluid intake
__________________________________
(From previous to this day morning, in mL , e.g.;
1250) 
4th day urine output
__________________________________
(From previous to this day morning, in mL , e.g.;
1250. Do not add extra losses, such as paracentesis or
thoracentesis) 
BUN after 4th day
__________________________________
(Fourth morning value after admission, in mg/dL ,
e.g.; 25)
Creatinine after 4th day
__________________________________
(Fourth morning value after admission, in mg/dL ,
e.g.; 1.5)
Sodium after 4th day
__________________________________
(Fourth morning value after admission, in mEq/L ,
e.g.; 135)
Potassium after 4th day
__________________________________
(Fourth morning value after admission, in mEq/L ,
e.g.; 4.5)
Total intravenous furosemide equivalent of loop
diuretic dose 
__________________________________
(40 mg furosemide po=20 mg furosemide iv=20 mg
torasemide po)
Total asetozolamide dose
(0 if not used)
__________________________________
Total thiazide dose
(0 if not used)
__________________________________
Total MRA dose
(0 if not used)
__________________________________
4th day venous pressure
__________________________________
(Value in the fourth morning after admission, in mmHg,
e.g..; 25)

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Page 15
Quality of waveform
Good (Clear atrial or respiratory pressure
oscillations)
(Interpret the visual quality of waveform)
Moderate (Less clear pressure oscillations but a
stable measurement with an appropriate
modified-Valsalva response)
Poor (No oscillations, increasing, no appropriate
modified-Valsalva response or nonphysiological
readings)
Discharged today (or follow-up is terminated for
Yes
another reason) ?
No
(If "Yes" these values will be accepted as
pre-discharge measurements.)
You do not need to input any data in this form as the in-hospital follow-up is ended. Please proceed to the next
instrument . 
(If in-hospital follow-up continues, check the previous form "Discharged today (or follow-up is terminated for another
reason) ? and change the answer to "No".)

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PERIPHERAL-HF
Page 16
In-hospital Course (5th day)
5th day fluid intake
__________________________________
(From previous to this day morning, in mL , e.g.;
1250) 
5th day urine output
__________________________________
(From previous to this day morning, in mL , e.g.;
1250. Do not add extra losses, such as paracentesis or
thoracentesis) 
BUN after 5th day
__________________________________
(Fifth morning value after admission, in mg/dL , e.g.;
25) 
Creatinine after 5th day
__________________________________
(Fifth morning value after admission, in mg/dL , e.g.;
1.5) 
Sodium after 5th day
__________________________________
(Fifth morning value after admission, in mEq/L , e.g.;
135) 
Potassium after 5th day
__________________________________
(Fifth morning value after admission, in mEq/L , e.g.;
4.5) 
Total intravenous furosemide equivalent of loop
diuretic dose 
__________________________________
(40 mg furosemide po=20 mg furosemide iv=20 mg
torasemide po)
Total asetozolamide dose
(0 if not used)
__________________________________
Total thiazide dose
(0 if not used)
__________________________________
Total MRA dose
(0 if not used)
__________________________________
5th day venous pressure
__________________________________
(Value in the fifth morning after admission, in mmHg,
e.g..; 25)

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Page 17
Quality of waveform
Good (Clear atrial or respiratory pressure
oscillations)
(Interpret the visual quality of waveform)
Moderate (Less clear pressure oscillations but a
stable measurement with an appropriate
modified-Valsalva response)
Poor (No oscillations, increasing, no appropriate
modified-Valsalva response or nonphysiological
readings)
Discharged today (or follow-up is terminated for
Yes
another reason) ?
No
(If "Yes" these values will be accepted as
pre-discharge measurements.)
You do not need to input any data in this form as the in-hospital follow-up is ended. Please proceed to the next
instrument . 
(If in-hospital follow-up continues, check the previous form "Discharged today (or follow-up is terminated for another
reason) ? and change the answer to "No".)

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PERIPHERAL-HF
Page 18
In-hospital Course (6th day)
6th day fluid intake
__________________________________
(From previous to this day morning, in mL , e.g.;
1250) 
6th day urine output
__________________________________
(From previous to this day morning, in mL , e.g.;
1250. Do not add extra losses, such as paracentesis or
thoracentesis) 
BUN after 6th day
__________________________________
(Sixth morning value after admission, in mg/dL , e.g.;
25) 
Creatinine after 6th day
__________________________________
(Sixth morning value after admission, in mg/dL , e.g.;
1.5) 
Sodium after 6th day
__________________________________
(Sixth morning value after admission, in mEq/L , e.g.;
135) 
Potassium after 6th day
__________________________________
(Sixth morning value after admission, in mEq/L , e.g.;
4.5) 
Total intravenous furosemide equivalent of loop
diuretic dose 
__________________________________
(40 mg furosemide po=20 mg furosemide iv=20 mg
torasemide po)
Total asetozolamide dose
(0 if not used)
__________________________________
Total thiazide dose
(0 if not used)
__________________________________
Total MRA dose
(0 if not used)
__________________________________
6th day venous pressure
__________________________________
(Value in the sixth morning after admission, in mmHg,
e.g..; 25)

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Page 19
Quality of waveform
Good (Clear atrial or respiratory pressure
oscillations)
(Interpret the visual quality of waveform)
Moderate (Less clear pressure oscillations but a
stable measurement with an appropriate
modified-Valsalva response)
Poor (No oscillations, increasing, no appropriate
modified-Valsalva response or nonphysiological
readings)
Discharged today (or follow-up is terminated for
Yes
another reason) ?
No
(If "Yes" these values will be accepted as
pre-discharge measurements.)
You do not need to input any data in this form as the in-hospital follow-up is ended. Please proceed to the next
instrument . 
(If in-hospital follow-up continues, check the previous form "Discharged today (or follow-up is terminated for another
reason) ? and change the answer to "No".)

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PERIPHERAL-HF
Page 20
In-hospital Course (7th day)
7th day fluid intake
__________________________________
(From previous to this day morning, in mL , e.g.;
1250) 
7th day urine output
__________________________________
(From previous to this day morning, in mL , e.g.;
1250. Do not add extra losses, such as paracentesis or
thoracentesis) 
BUN after 7th day
__________________________________
(Seventh morning value after admission, in mg/dL ,
e.g.; 25)
Creatinine after 7th day
__________________________________
(Seventh morning value after admission, in mg/dL ,
e.g.; 1.5)
Sodium after 7th day
__________________________________
(Seventh morning value after admission, in mEq/L ,
e.g.; 135)
Potassium after 7th day
__________________________________
(Seventh morning value after admission, in mEq/L ,
e.g.; 4.5)
Total intravenous furosemide equivalent of loop
diuretic dose 
__________________________________
(40 mg furosemide po=20 mg furosemide iv=20 mg
torasemide po)
Total asetozolamide dose
(0 if not used)
__________________________________
Total thiazide dose
(0 if not used)
__________________________________
Total MRA dose
(0 if not used)
__________________________________
7th day venous pressure
__________________________________
(Value in the seventh morning after admission, in
mmHg, e.g..; 25) 

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Quality of waveform
Good (Clear atrial or respiratory pressure
oscillations)
(Interpret the visual quality of waveform)
Moderate (Less clear pressure oscillations but a
stable measurement with an appropriate
modified-Valsalva response)
Poor (No oscillations, increasing, no appropriate
modified-Valsalva response or nonphysiological
readings)
Discharged today (or follow-up is terminated for
Yes
another reason) ?
No
(If "Yes" these values will be accepted as
pre-discharge measurements.)
You do not need to input any data in this form as the in-hospital follow-up is ended. Please proceed to the next
instrument . 
(If in-hospital follow-up continues, check the previous form "Discharged today (or follow-up is terminated for another
reason) ? and change the answer to "No".)

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PERIPHERAL-HF
Page 22
In-hospital Adverse Events
Technical problems in pressure monitorization
(Unable to measure venous pressure on admission,
before pre-discharge or on three consecutive days)
*Criterion for exclusion from long-term follow-up (If
admission and predischarge pressures cannot be
measured) !
Yes
No
Symptomatic hypotension requiring intervention
(Systolic blood pressure < 90 mmHg requiring fluid
resuscitation or vasopressor use.)
Yes
No
Any need for high dose inotropes or mechanical support
(intraaortic balloon etc.) 
(>10 mcg/kg/min dopamine or dobutamine, any dose of
noradrenaline or adrenaline. Milrinon or levosimendan
can be ignored.)
*Criterion for exclusion from long-term follow-up !
Yes
No
The development of clinical thrombophylebitis
(Redness, warmness or tenderness on any previously
used vein)
Yes
No
Any need for veno-venous hemofiltration or dialysis
(Any unplanned need for veno-venous hemofiltration or
dialysis during hospitalization.)
*Criterion for exclusion from long-term follow-up !
Yes
No
In-hospital intubation
*Criterion for exclusion from long-term follow-up !
Yes
No
In-hospital cardiopulmonary resuscitation
*Criterion for exclusion from long-term follow-up !
Yes
No
Exclusion date
__________________________________
In-hospital mortality
*Criterion for exclusion from long-term follow-up !
Yes
No
Mortality date
__________________________________

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PERIPHERAL-HF
Page 23
Predischarge Findings
As an in-hospital safety endpoint has occured, this patient has been excluded from long-term follow-up. You do not
need to fill any measurement on this page.
(If this has not occured and you think this is a mistake, please check the form entitled "In-hospital adverse events".)
Dischareg date
__________________________________
(Select as day, month and year.)
Subjective dyspnea score
None
Rare
Frequent
Always
Subjective orthopnea score
None
Rare
Frequent
Always
Subjective fatigue score
None
Rare
Frequent
Always
Pretibial edema
None
1+
2+
3+
4+
Pulmonary rales
None
Limited to the bases
Lower half
More than lower half
Jugular venous distention
(Compared to angle of Louis while lying at 45 degree supine position.)
Unobservable
Normal (< 4.5 cm)
High (>4.5 cm) but pulsations can be seen
Exceeds angulus mandibula
BUN on discharge
(Just before discharge, in mg/dL, e.g.; 12)
__________________________________

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Creatinine on discharge 
(Just before discharge, in mg/dL, e.g.; 1.2)
__________________________________
Sodium on discharge
(Just before or after admission, in mEq/L, e.g.; 142)
__________________________________
Potassium on discharge
(Just before discharge, in mEq/L, e.g.; 4.2)
__________________________________
Hemoglobin on discharge
(Just before discharge, in g/dL, e.g.; 12.3)
__________________________________
Hematocrit on discharge
(Just before discharge, in %, e.g.; 31)
__________________________________
Albumin on discharge
(Just before discharge, in g/dL, e.g.; 3.1)
__________________________________
Total protein on discharge
(Just before discharge, in g/dL, e.g.; 5.2)
__________________________________
BNP/NT-proPNP on discharge
(Just before discharge, in pg/mL, e.g.; 125)
__________________________________
Uric acid on discharge
(Just before discharge, in mg/dL, e.g.; 5.5)
__________________________________
Weight
(Just before discharge, in kilograms)
__________________________________
Additions to total negative balance
(Additional fluid losses, such as paracentesis,
__________________________________
thoracentesis, in mL. E.g., 1.200. If absent, enter
0.)
Venous pressure
__________________________________
(in mmHg; e.g., 5. If the subject is in standard
therapy arm, caregiver should be blinded to this
measurement.)
Quality of waveform
Good (Clear atrial or respiratory pressure
oscillations)
(Interpret the visual quality of waveform)
Moderate (Less clear pressure oscillations but a
stable measurement with an appropriate
modified-Valsalva response)
Poor (No oscillations, increasing, no appropriate
modified-Valsalva response or nonphysiological
readings)

projectredcap.org
PERIPHERAL-HF
Page 25
Treatment on Discarge
As an in-hospital safety endpoint has occured, this patient has been excluded from long-term follow-up. You do not
need to fill any measurement on this page.
(If this has not occured and you think this is a mistake, please check the form entitled "In-hospital adverse events".)
Aspirin
(Prescribed medications at discharge)
Yes
No
P2Y12 inhibitor
(Prescribed medications at discharge)
Yes
No
OAC/NOAC
(Prescribed medications at discharge)
Yes
No
Beta-blocker
(Prescribed medications at discharge)
Yes
No
ACEi/ARB
(Prescribed medications at discharge)
Yes
No
ARNI
(Prescribed medications at discharge)
Yes
No
SGLT2i
(Prescribed medications at discharge)
Yes
No
MRA
(Prescribed medications at discharge)
Yes
No
Loop diuretic
(Prescribed medications at discharge)
Yes
No
Oral furosemide equivalent loop diuretic dose 
(40 mg furosemide po=20 mg furosemide iv=20 mg
__________________________________
torasemide po)
Digoxin
(Prescribed medications at discharge)
Yes
No
Statin
(Prescribed medications at discharge)
Yes
No

projectredcap.org
PERIPHERAL-HF
Page 26
Long-term Follow-up
As an in-hospital safety endpoint has occured, this patient has been excluded from long-term follow-up. You do not
need to fill any measurement on this page.
(If this has not occured and you think this is a mistake, please check the form entitled "In-hospital adverse events".)
Long-term mortality
(Death in the first year)
Yes
No
Unknown
Mortality date
__________________________________
All-cause long-term hospitalization
(Emergency department visit or hospital admission due
to any cause in the first year)
Yes
No
Unkonwn
Date of all-cause hospitalization
(The first date of emergency department visit or
__________________________________
hospital admission due to any cause in the first year)
Long-term hospitalization due to HF
(Emergency department visit or hospital admission due
to HF in the first year)
Yes
No
Unknown
Date of HF-related hospitalization
(The first date of emergency department visit or
__________________________________
hospital admission due to HF in the first year)