Evaluation of Blood Volume Analysis- Guided Management of Decompensated Heart Failure

Study Overview
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Brief Summary
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Diuretic therapy is first-line treatment for acute decompensated heart failure. However, accurate assessment and management of patient blood volume is challenged by the limitations of physical exam and surrogate markers for blood volume. The study primary objective is to determine if goal-directed care as quantified by direct Blood Volume Analysis (Daxor BVA-100™) in addition to usual care results in more appropriate treatment and consistent achievement of euvolemia.

Detailed Description
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Over 6 million Americans suffer from heart failure, one of the most prevalent and deadly diseases in the United States. High rates of rehospitalization and mortality and treatment costs have persisted for decades despite advances in care. Clinical guidelines recommend assessment of blood volume and clinical management to euvolemia or normal blood volume, but standard methods of diagnosing blood volume status have been shown to be unreliable. Blood Volume Analysis (Daxor BVA-100) is based on the gold standard indicator dilution technique. BVA has been used to quantify otherwise undiagnosed blood volume derangements and guide treatment in heart failure and other indications. Also, retrospective analyses have shown that care of heart failure patients guided by BVA is associated with improved rates of rehospitalization and mortality. The proposed study is a prospective, two-center, parallel design, interventional, single-blinded pilot study of the potential for BVA to positively impact the treatment decisions of ADHF clinicians.

Official Title
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Evaluation of Blood Volume Analysis- Guided Management of Decompensated Heart Failure

Conditions
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Acute Decompensated Heart Failure

Intervention / Treatment
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* Diagnostic Test: BVA-100


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age > 18 years. In accordance with the Inclusion Across the Lifespan policy, Children will be excluded from the proposed study. ADHF is a condition that rarely affects children and Daxor's BVA-100 lack the reference norms for pediatric use. Admission to the hospital with a primary diagnosis of ADHF. Able and willing to provide informed written consent. Exclusion Criteria: Evidence of acute coronary syndrome or myocardial infarction during qualifying ADHF hospitalization. Evidence of hypertensive crisis or acute valvular regurgitation. The following has occurred within the last 3 months or is planned within the following 3 months: Revascularization procedure. Placement on cardiac transplantation list. Other major cardiac surgery or other surgery. Planned intermittent or continuous intravenous positive inotropic therapy. Severe chronic kidney disease (eGFR<15 ml/min). Psycho-social factors that interfere with ability to adhere to study procedures (severe dementia, active substance abuse, poorly controlled psychiatric illnesses). Pregnant women or nursing mothers. Women of childbearing potential not using adequate birth control methods. Known hypersensitivity to iodine or eggs. Participation in another heart failure investigational treatment protocol currently or <30 days prior to enrollment. Evidence of active bleeding or active hemolysis. Hemoglobin measured below 7 g/dl or hematocrit measured below 21%. Patient has received a heart transplant and/or currently treated with mechanical circulatory support. Patients implanted with invasive hemodynamic monitors (i.e. CardioMEMS).

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
Interventional Model Description: Prospective, two-center, parallel design, interventional, single-blinded pilot study
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Standard care group<br>Blood Volume Analysis will be performed at admission, during inpatient stay if warranted, and prior to hospital discharge. Treating physicians will be blinded to the results and will choose between a low-moderate and high diuretic dose based on usual care clinical assessment of volume status. | Diagnostic Test: BVA-100<br>* The BVA-100 is a medical device that calculates human blood volume using the method of tracer dilution. The device utilizes a tracer of human serum albumin tagged with iodine-131 to measure injected intravascularly and a series of timed blood draws. The amount of tracer in each blood draw is used to calculate the unknown blood volume. Data inputs come from the measured characteristics of subject blood samples (hematocrit and tracer concentration) and tracer calibration standards. The package also calculates the subject expected (or ideal) blood volume from physical parameters. Hyper- or hypovolemia, associated red blood cell volumes, and tracer transudation rate are reported, with statistics showing the quality of the results.<br>|
| Experimental: BVA-guided treatment arm<br>Blood Volume Analysis will be performed at admission, during inpatient stay if warranted, and prior to hospital discharge. Treating physicians will receive the results and will choose between a low-moderate and high diuretic dose based on measured volume status. | Diagnostic Test: BVA-100<br>* The BVA-100 is a medical device that calculates human blood volume using the method of tracer dilution. The device utilizes a tracer of human serum albumin tagged with iodine-131 to measure injected intravascularly and a series of timed blood draws. The amount of tracer in each blood draw is used to calculate the unknown blood volume. Data inputs come from the measured characteristics of subject blood samples (hematocrit and tracer concentration) and tracer calibration standards. The package also calculates the subject expected (or ideal) blood volume from physical parameters. Hyper- or hypovolemia, associated red blood cell volumes, and tracer transudation rate are reported, with statistics showing the quality of the results.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Quantitative assessment of progress to euvolemic target for both subjects and controls | Accurately quantify levels and changes to blood volume and red blood cell volume in ADHF inpatients during inpatient stay, and use this data to guide diuretic therapy in the treatment arm. | Approximately 2 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Quantitative assessment of event-based outcome metrics | 30-day readmission and mortality outcomes will be quantified for both cohorts. | 30 days post discharge | 
| Quantitative assessment of continuous outcome metrics: weight | Measure and compare changes to body weight in kilogram | Approximately 2 weeks | 
| Quantitative assessment of continuous outcome metrics: net fluid balance | Measure and compare changes to net fluid balance in mL | Approximately 2 weeks | 
| Quantitative assessment of continuous outcome metrics: natriuretic peptide | Measure and compare changes to natriuretic peptide in pg/mL | Approximately 2 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Heart Failure, Blood Volume