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Acute Decompensated Heart FailureCAT-HFNCT01953874

Cardiovascular Improvements With MV ASV Therapy in Heart Failure

A study testing MV ASV and Optimized Medical Treatment in people with Acute Decompensated Heart Failure and Sleep Disordered Breathing, run by ResMed at 15 sites in 2 countries.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

The aim of the study is to compare the effects of MV targeted ASV in addition to optimized medical therapy versus optimized medical therapy alone at 6 months in patients with acute decompensated HF. The study will also assess changes in functional parameters, biomarkers, quality of life (QOL), and sleep. Read more about this study

Who is it for?
Ages 21 years and older
What is being tested?
MV ASV and Optimized Medical Treatment
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
126 participants
Where
15 sitesin 2 countries
Study dates
Dec 2013to Dec 2015
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 21 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patients 21 years or older
  • Patients with prior clinical diagnosis of heart failure (HFrEF or HFpEF), or de novo diagnosis of HFpEF indicated by a local BNP≥300 pg/mL or NT pro-BNP≥1200 pg/mL on admission without systolic blood pressure >180 mmHg or atrial fibrillation, or diagnosis of HFrEF indicated by documented evidence of prescribed beta-blockers and ACE-inhibitors or ARBs for at least 4 weeks prior to admission
  • Hospital admission for acute decompensated HF as determined by:
  • Dyspnea at rest or with minimal exertion
  • AND At least two of the following signs and symptoms:
  • Orthopnea
Show all 14Show fewer
  • Pulmonary rales beyond basilar
  • Chest congestion on x-ray
  • BNP≥300pg/mL or NT pro-BNP≥1200pg/mL
  • Pulmonary capillary wedge pressure (PCWP) ≥25mmHg during current hospitalization
  • Presented to hospital or clinic at least 24 hours prior to consent
  • Patient stable enough to stop oxygen use for duration of polygraphy test or have access to dual lumen cannula for polygraphy test
  • Sleep disordered breathing (SDB) documented by polygraphy with an AHI≥15 events/hour
  • Patient is able to fully understand study information and sign a consent form

Who cannot join

  • Right-sided heart failure without left-sided heart failure
  • Sustained systolic blood pressure <80 mmHg at baseline
  • Acute coronary syndrome within 1 months of randomization
  • Active myocarditis
  • Complex congenital heart disease
  • Constrictive pericarditis
Show all 29Show fewer
  • Non-cardiac pulmonary edema
  • Clinical evidence of digoxin toxicity
  • Need for mechanical hemodynamic support at time of randomization
  • Oxygen saturation ≤85% at rest during the day or at start of nocturnal oximetry recording or regular use of oxygen therapy (day or night)
  • COPD exacerbation as the primary reason for hospital admission
  • Current use (within 4 weeks of study entry) of any PAP-therapy (eg, fixed, bi-level, or APAP)
  • Life expectancy < 1 year for diseases unrelated to HF
  • Transient ischemic attack (TIA) or Stroke within 3 months prior to randomization
  • CABG procedure within 3 months prior to randomization, or planned to occur during study period
  • CRT implant within 3 months prior to randomization , or planned to occur during study period
  • VAD implant planned to occur during study period
  • Heart transplant list Status 1a or 1b
  • Status post-transplant or LVAD
  • Prescribed inotrope therapy anticipated at discharge
  • Chronic Dialysis
  • Known amyloidosis, hypertrophic obstructive cardiomyopathy, arteriovenous fistulas
  • Primary hemodynamically significant uncorrected valvular heart disease (obstructive or regurgitant) with planned intervention within 6 months of randomization
  • Pregnant, or planning to become pregnant
  • Cannot tolerate ASV treatment during run-in
  • Cannot perform 6MWT at baseline
  • Occupation as a commercial driver or pilot and plan to be performing these activities during the study period
  • Inability to comply with planned study procedures
  • Participation in pharmaceutical or treatment-related clinical study within 1 month of study enrollment

Trial locations and contacts

15 sites in 2 countries.

15 sites in 2 countries

United States14 sites
  • University of Maryland

    Baltimore, Maryland, 21201

  • Northwestern University

    Chicago, Illinois, 60611

  • University of Cincinnati

    Cincinnati, Ohio, 45267

  • VA Medical Center

    Denver, Colorado, 80220

  • Duke University Medical Center

    Durham, North Carolina, 27710

  • Penn State Hershey

    Hershey, Pennsylvania, 17033

  • The Heart Center

    Huntsville, Alabama, 35801

  • St. Luke's Hospital of Kansas City

    Kansas City, Missouri, 64111

  • VA Greater Los Angeles Healthcare System

    Los Angeles, California, 90073

  • Mercer University

    Macon, Georgia, 31201

  • Sentara Cardiovascular Research Institute

    Norfolk, Virginia, 23507

  • Jefferson Heart Institute

    Philadelphia, Pennsylvania, 19107

  • University of Washington

    Seattle, Washington, 98195

  • Washington University School of Medicine

    St Louis, Missouri, 63110

Other trials in United States

Germany1 site
  • Heart and Diabetes Center - North Rhine-Westphalia (HDZ-NRW)

    Bad Oeynhausen

Other trials in Germany

About this study

Official title: Cardiovascular Improvements With Minute Ventilation-targeted ASV Therapy in Heart Failure (CAT-HF)

The aim of the study is to compare the effects of MV targeted ASV in addition to optimized medical therapy versus optimized medical therapy alone at 6 months in patients with acute decompensated HF. The study will also assess changes in functional parameters, biomarkers, quality of life (QOL), and sleep.

Read the detailed description

This study is a randomized, unblinded, multi-center trial with parallel group design, with subjects randomized to either control (optimized medical therapy for chronic heart failure) or active treatment (optimized medical therapy plus use of MV-targeted ASV) in a 1:1 ratio.

Being tested
MV ASV, Optimized Medical Treatment
Keywords
heart failure, congestive heart failure, acute decompensated heart failure, chronic heart failure, left-sided heart failure, heart failure decompensation, sleep apnea, sleep disordered breathing, central sleep apnea, obstructive sleep apnea, cheyne-stokes respiration
Medical subject headings
Sleep Apnea Syndromes, Heart Failure, Sleep Apnea, Central, Sleep Apnea, Obstructive, Cheyne-Stokes Respiration

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • MV ASVDevice

    Also called VPAP Adapt, AutoSet CS

    Minute ventilation-targeted servo-ventilation therapy.

  • Optimized Medical TreatmentDrug

    Beta Blockers, ACE inhibitor or ARB, loop diuretics and/or spironolactone as appropriate, statin if indicated, aspirin and/or warfarin if indicated

Study groups in NCT01953874
Study groupRoleWhat they receive
MV ASV+OMTExperimentalMinute Ventilation-targeted adaptive servo-ventilation therapy plus optimized medical treatment
Receives: Device: MV ASV; Drug: Optimized Medical Treatment
OMT onlyActive comparatorOptimized Medical Treatment for heart failure in accordance with applicable guidelines (ACCF/AHA Guideline for the Management of Heart Failure and HFSA Heart Failure Guidelines.
Receives: Drug: Optimized Medical Treatment

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Global Rank Endpoint

    A rank order response based on survival free from CV hospitalization and improvement in functional capacity measured by 6MWD. All participants were first ranked by time to death, then ranked by time to CV hospitalization, and then ranked by percentage change in 6MWD. For time to event measures (time to death and time to hospitalization), the shorter the amount of time, the lower the rank assigned to that participant. For percentage changes in 6MWD, the smaller the percentage change, the lower the rank assigned to that participant. Each component was then combined to create a rank value that ranged between 0 and 100. Overall, higher rank values are associated with better outcomes.

    Measured: Baseline, 6 months

Secondary outcomes (19)
  1. Six-minute Walk Distance

    Change in functional parameters as measured by 6-minute walk test (6MWT)

    Measured: Change from Baseline to 6 months

  2. NT Pro-BNP

    Change in neurohumoral activation as measured by N-terminal pro b-type natriuretic peptide.

    Measured: Change from Baseline to 6 months

  3. Kansas City Cardiomyopathy Questionnaire (KCCQ)

    The KCCQ is a 23-item, self-administered instrument that quantifies physical function, symptoms (frequency, severity and recent change), social function, self-efficacy and knowledge, and quality of life. Scores are transformed to a range of 0-100, in which higher scores reflect better health status.

    Measured: Change from Baseline to 6 months

  4. Biomarkers - Inflammation

    Biomarkers of inflammation reported as troponin I ultra-sensitive

    Measured: Change from Baseline to 6 months

  5. Biomarkers - Cardiovascular

    Biomarkers of cardiovascular function reported as hs-CRP

    Measured: Change from Baseline to 6 months

  6. Biomarkers - Renal Function

    Biomarkers of renal function reported as creatinine

    Measured: Change from Baseline to 6 months

  7. ECHO Parameters - LVEF

    Echocardiographic parameters, including LVEF (left ventricular ejection fraction) and LVESVI (left ventricular end-systolic volume index) for patients with HFrEF (heart failure with reduced ejection fraction), and E/e' (ratio between early mitral inflow velocity and mitral annular early diastolic velocity) for patients with HFrEF or HFpEF (heart failure with preserved ejection fraction).

    Measured: Change from Baseline to 6 months

  8. ECHO Parameters - LVESVI

    Echocardiographic parameters, including LVEF (left ventricular ejection fraction) and LVESVI (left ventricular end-systolic volume index) for patients with HFrEF (heart failure with reduced ejection fraction), and E/e' (ratio between early mitral inflow velocity and mitral annular early diastolic velocity) for patients with HFrEF or HFpEF (heart failure with preserved ejection fraction).

    Measured: Change from Baseline to 6 months

  9. ECHO Parameters - E/e' Ratio

    Echocardiographic parameters, including LVEF (left ventricular ejection fraction) and LVESVI (left ventricular end-systolic volume index) for patients with HFrEF (heart failure with reduced ejection fraction), and E/e' (ratio between early mitral inflow velocity and mitral annular early diastolic velocity) for patients with HFpEF (heart failure with preserved ejection fraction).

    Measured: Change from Baseline to 6 months

  10. Win Ratio

    Patients in the new treatment and control groups are formed into matched pairs based on their risk profiles. For each matched pair, the new treatment patient is labeled a 'winner' or a 'loser' depending on who had a CV death first. If that is not known, they are labeled a 'winner' or 'loser' depending on who had a HF hospitalization first. Otherwise they are considered tied. The win ratio is the total number of winners divided by the total numbers of losers.

    Measured: 6 months

  11. Sleep Parameters

    Sleep and sleep disordered breathing parameters (AHI, nocturnal hypoxemia)

    Measured: Change from Baseline to 6 months

  12. Number of Subjects With HF Hospitalization

    Rates of hospitalization or urgent clinic visit for worsening of heart failure and for any reason

    Measured: 2 days, 1 week, 1, 2, 3, and 6 months

  13. Death

    Rate of Cardiovascular and all-cause death

    Measured: 2 days, 1 week, 1, 2, 3, and 6 months

  14. Time Dead/Hospitalized

    Total days dead or hospitalized at study end

    Measured: 6 months

  15. DASI

    The Duke Activity Status Index is a 12-item patient-reported outcome validated for the assessment of functional capacity based on the ability to perform everyday activities. With a total range of 0 to 58.20, a higher score indicates better quality of life.

    Measured: Change from Baseline to 6 months

  16. EQ-5D-5L Index

    The EQ-5D-5L is a standardized self-report questionnaire that is used as a measure of health outcome. The EQ-5D-5L questionnaire is comprised of the following 5 dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 5 levels: no problems, slight problems, moderate problems, severe problems, and extreme problems. Responses were indexed using the EQ-5D-5L US value set to scale the 5 dimensions. A score of -0.109 indicates extreme problems for all dimensions and a score of 1.000 indicates no problems for all dimensions. Therefore, a higher score indicates better general health.

    Measured: Change from Baseline to 6 months

  17. PHQ-9

    The PHQ-9 is the nine item depression scale of the Patient Health Questionnaire. The PHQ-9 is a self-administered instrument for screening, diagnosing, monitoring and measuring the severity of depression. The PHQ-9 incorporates DSM-IV depression diagnostic criteria with other leading major depressive symptoms into a brief self-report tool. The tool rates the frequency of the symptoms which factors into the following scoring severity index: 0 - Not at all, 1 - Several Days, 2 - More than Half the Days, 3 - Nearly Every Day. Total score can range from 0 to 27. A higher score indicates increased severity.

    Measured: Change from Baseline to 6 months

  18. PSQI

    The Pittsburgh Sleep Quality Index is a 19-item subjective measurement of sleep. It is an effective instrument used to measure the quality and patterns of sleep in the older adult. It differentiates "poor" from "good" sleep by measuring seven areas: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication and daytime dysfunction over the last month. The subject self-rates each of these seven areas of sleep. The seven component scores are then added to yield a total score with a range of 0-21 points, "0" indicating no difficulty and "21" indicating severe difficulties in all areas.

    Measured: Change from Baseline to 6 months

  19. ESS

    The Epworth Sleepiness Scale is a simple, 8-item self-administered questionnaire which provides a measurement of the subject's general level of daytime sleepiness. The individual is asked on a scale of 0-3 to score the likelihood of falling asleep in eight various situations. With a total range of 0 to 24, a higher score indicates increased severity.

    Measured: Change from Baseline to 6 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted1 Oct 2013 (estimated)
  2. Study startDec 2013
  3. Primary completionDec 2015
  4. Study completionDec 2015

Why it stopped: SERVE-HF results showed ASV increased CV mortality in patients with reduced LVEF

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Supportive care
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
126 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01953874
Sponsor's protocol ID
MA-12-12-01
Acronym
CAT-HF
Status last verified
Jan 2018
First submitted
23 Sep 2013
Last updated
28 Feb 2018
Data monitoring committee
Yes

Publications

  • Piccini JP, Pokorney SD, Anstrom KJ, Oldenburg O, Punjabi NM, Fiuzat M, Tasissa G, Whellan DJ, Lindenfeld J, Benjafield A, Woehrle H, Blase A, O'Connor CM. Adaptive servo-ventilation reduces atrial fibrillation burden in patients with heart failure and sleep apnea. Heart Rhythm. 2019 Jan;16(1):91-97. doi: 10.1016/j.hrthm.2018.07.027. Epub 2018 Jul 27.

    PubMed 30059750
  • O'Connor CM, Whellan DJ, Fiuzat M, Punjabi NM, Tasissa G, Anstrom KJ, Benjafield AV, Woehrle H, Blase AB, Lindenfeld J, Oldenburg O. Cardiovascular Outcomes With Minute Ventilation-Targeted Adaptive Servo-Ventilation Therapy in Heart Failure: The CAT-HF Trial. J Am Coll Cardiol. 2017 Mar 28;69(12):1577-1587. doi: 10.1016/j.jacc.2017.01.041.

    PubMed 28335841
  • Fiuzat M, Oldenberg O, Whellan DJ, Woehrle H, Punjabi NM, Anstrom KJ, Blase AB, Benjafield AV, Lindenfeld J, O'Connor CM. Lessons learned from a clinical trial: Design, rationale, and insights from The Cardiovascular Improvements with Minute Ventilation-targeted Adaptive Sero-Ventilation (ASV) Therapy in Heart Failure (CAT-HF) Study. Contemp Clin Trials. 2016 Mar;47:158-64. doi: 10.1016/j.cct.2016.01.001. Epub 2016 Jan 19.

    PubMed 26806668

Questions about this trial

What is this clinical trial studying?

A study testing MV ASV and Optimized Medical Treatment in people with Acute Decompensated Heart Failure and Sleep Disordered Breathing, run by ResMed at 15 sites in 2 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 14 inclusion and 29 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: stopped early, as of the sponsor's last update on 28 Feb 2018. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 15 sites in United States, Germany. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 28 Feb 2018). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Global Rank Endpoint (time frame: Baseline, 6 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01953874, which also lists 3 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 28 Feb 2018.

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