Comparing Diuretic Strategies in Hospitalized Heart Failure

Study Overview
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Brief Summary
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We will conduct a pragmatic randomized trial comparing whether using a combination of two types of diuretics (loop + thiazide) compared with using a single diuretic (loop only) will result in shorter hospital stays for patients hospitalized with heart failure.

Official Title
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Creating a Platform for Point-of-Care Pragmatic Clinical Trials: Comparing Diuretic Strategies in Heart Failure

Conditions
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Heart Failure

Intervention / Treatment
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* Drug: Loop Diuretics vs. loop + thiazide diuretics


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Any adult (age ≥18 years) admitted to the Heart Failure Service at Stanford Health Care with an indication for treatment with a diuretic. Exclusion Criteria: admission to the intensive care unit or cardiac care units maintenance dialysis on admission any mechanical circulatory support on admission history of heart transplant allergy / intolerance to loop or thiazide diuretics admission serum sodium < 125 meq/L (from EPIC) admission serum potassium < 3.0 meq/L (from EPIC)

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Loop only<br>Participants will receive a loop diuretic for up to the first 72 hours of hospitalization. The specific drug, dose and route are left to the treating providers. | Drug: Loop Diuretics vs. loop + thiazide diuretics<br>* Participants will receive the diuretic type as determined by the randomized group assignment starting within the first 24 hours of hospital admission and continuing for up to 72 hours. All other treatments are left to the discretion of the treatment team, as this is a pragmatic randomized trial.<br>|
| Active Comparator: Loop + Thiazide<br>Participants will receive a loop+thiazide diuretic for up to the first 72 hours of hospitalization. The specific drugs, doses and routes are left to the treating providers. | Drug: Loop Diuretics vs. loop + thiazide diuretics<br>* Participants will receive the diuretic type as determined by the randomized group assignment starting within the first 24 hours of hospital admission and continuing for up to 72 hours. All other treatments are left to the discretion of the treatment team, as this is a pragmatic randomized trial.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hospital length of stay |  | During hospitalization up to 90 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Composite of all-cause rehospitalizations, emergency department visits, or death in the 30 days after hospital discharge. |  | 30 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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diuretics