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Heart Failure With Reduced Ejection Fraction (HFrEF)Phase 3NCT03877237

DETERMINE-reduced - Dapagliflozin Effect on Exercise Capacity Using a 6-minute Walk Test in Patients With Heart Failure With Reduced Ejection Fraction

A Phase 3 study testing Dapagliflozin in people with Heart Failure With Reduced Ejection Fraction (HFrEF), run by AstraZeneca at 76 sites in 9 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
Search all trials

Trial summary

International, Multicentre, Parallel-group, Randomised, Double-blind, Placebo-controlled, Phase III Study Evaluating the effect of Dapagliflozin on Exercise Capacity in Heart Failure Patients with Reduced Ejection Fraction (HFrEF) Read more about this study

Who is it for?
Ages 18 to 150 years
What is being tested?
Dapagliflozin
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
313 participants
Where
76 sitesin 9 countries
Study dates
9 Apr 2019to 7 Mar 2020
Phase
Phase 3
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 18 to 150 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Provision of signed informed consent prior to any study specific procedures
  • Male or female, aged ≥18 years
  • Documented diagnosis of symptomatic HFrEF (NYHA functional class II-IV), which has been present for at least 8 weeks
  • LVEF≤40%
  • Elevated NT-proBNP levels
  • Patients should receive background standard of care as described below: All HFrEF patients should be treated according to locally recognised guidelines on standard of care treatment with both drugs and devices, as appropriate. Guideline-recommended medications should be used at recommended doses unless contraindicated or not tolerated. Therapy should have been individually optimised and stable for ≥4 weeks (this does not apply to diuretics) before visit 1 and include (unless contraindicated or not tolerated):
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  • an ACE inhibitor, or ARB or sacubitril/valsartan and
  • a beta-blocker and
  • if considered appropriate by the patient's treating physician; a mineral corticoid receptor antagonist
  • 6MWD≥100 metres and ≤425 metres at enrolment and randomization.

Who cannot join

  • Presence of any condition that precludes exercise testing
  • Participation in a structured exercise training programme in the 1 month prior to screening or planned to start during the trial
  • Receiving therapy with an SGLT2 inhibitor within 4 weeks prior to enrolment or previous intolerance of an SGLT2 inhibitor
  • Type 1 diabetes mellitus
  • eGFR <25 mL/min/1.73 m2 (CKD-EPI formula) at enrolment, unstable or rapidly progressing renal disease at time of randomisation
  • Systolic BP <95 mmHg on 2 consecutive measurements
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  • Systolic BP ≥160 mmHg if not on treatment with ≥3 blood pressure lowering medications or ≥180 mmHg irrespective of treatments, on 2 consecutive measurements
  • Current acute decompensated HF or hospitalisation due to decompensated HF <4 weeks prior to enrolment
  • MI, unstable angina, coronary revascularization ablation of atrial flutter/fibrillation, valve repair/replacement, implantation of a cardiac resynchronization therapy device within 12 weeks prior to enrolment or planned to undergo any of these operations after randomization.
  • Stroke or transient ischemic attack within 12 weeks prior to enrolment.
  • Primary pulmonary hypertension, chronic pulmonary embolism, severe pulmonary disease including COPD.
  • Previous cardiac transplantation or implantation of a ventricular assistance device or similar device, or implantation expected after randomization
  • HF due to infiltrative cardiomyopathy, active myocarditis, constrictive pericarditis, cardiac tamponade, known genetic hypertrophic cardiomyopathy or obstructive hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy/dysplasia, or uncorrected primary valvular disease

Trial locations and contacts

76 sites in 9 countries.

76 sites in 9 countries

United States23 sites
  • Research Site

    Abington, Pennsylvania, 19001

  • Research Site

    Alexander City, Alabama, 35010

  • Research Site

    Beverly Hills, California, 90211

  • Research Site

    Buffalo, New York, 14215

  • Research Site

    Burlington, North Carolina, 27215

  • Research Site

    Fairhope, Alabama, 36532

  • Research Site

    Falls Church, Virginia, 22042

  • Research Site

    Fort Payne, Alabama, 35967

  • Research Site

    Kansas City, Missouri, 64111

  • Research Site

    Miami, Florida, 33133

  • Research Site

    Miami, Florida, 33173

  • Research Site

    Mobile, Alabama, 36608

  • Research Site

    Munster, Indiana, 46321

  • Research Site

    New Brunswick, New Jersey, 08901

  • Research Site

    New York, New York, 10001

  • Research Site

    Petoskey, Michigan, 49770

  • Research Site

    Pittsburgh, Pennsylvania, 15212

  • Research Site

    Rosedale, New York, 11422

  • Research Site

    Seattle, Washington, 98101

  • Research Site

    Stamford, Connecticut, 06905

  • Research Site

    Torrance, California, 90502

  • Research Site

    Tucker, Georgia, 30084

  • Research Site

    Tullahoma, Tennessee, 37388

Other trials in United States

Canada16 sites
  • Research Site

    Ajax, Ontario, L1Z 0B1

  • Research Site

    Gatineau, Quebec, J8Y 6S8

  • Research Site

    Longueuil, Quebec, J4M 2X1

  • Research Site

    Moncton, New Brunswick, E1G 1A7

  • Research Site

    Montreal, Quebec, H2X 0A9

  • Research Site

    North York, Ontario, M3M 3E5

  • Research Site

    Oshawa, Ontario, L1J 2K1

  • Research Site

    Québec, Quebec, G1G 3Z4

  • Research Site

    Québec, Quebec, G2J 0C4

  • Research Site

    Québec, Quebec, G3K 2P8

  • Research Site

    Saint-Georges, Quebec, G5Y 4T8

  • Research Site

    Scarborough Village, Ontario, M1E 5E9

  • Research Site

    St. John's, Newfoundland and Labrador, A1B 3V6

  • Research Site

    Stoney Creek, Ontario, L8J 3W2

  • Research Site

    Winnipeg, Manitoba, R2H 2A6

  • Research Site

    York, Ontario, M9N 1W4

Other trials in Canada

Denmark10 sites
  • Research Site

    Århus N, 8200

  • Research Site

    Copenhagen, 2300

  • Research Site

    Esbjerg, 6700

  • Research Site

    Hellerup, 2900

  • Research Site

    Hjørring, 9800

  • Research Site

    Hvidovre, 2650

  • Research Site

    Næstved, 4700

  • Research Site

    Odense C, 5000

  • Research Site

    Randers, 8930

  • Research Site

    Svendborg, DK-5700

Other trials in Denmark

Japan8 sites
  • Research Site

    Daito-shi, 574-0074

  • Research Site

    Kobe, 654-0155

  • Research Site

    Matsubara-shi, 580-0032

  • Research Site

    Naha, 902-8511

  • Research Site

    Osaka, 530-0001

  • Research Site

    Sayama-shi,, 350-1305

  • Research Site

    Shunan-shi, 745-0822

  • Research Site

    Takarazuka-shi, 665-0873

Other trials in Japan

Sweden6 sites
  • Research Site

    Gothenburg, 413 45

  • Research Site

    Lund, 222 21

  • Research Site

    Östersund, 831 83

  • Research Site

    Stockholm, 114 46

  • Research Site

    Stockholm, 118 83

  • Research Site

    Umeå, 90737

Other trials in Sweden

Brazil4 sites
  • Research Site

    Blumenau, 89020-430

  • Research Site

    Porto Alegre, 91350-200

  • Research Site

    São Paulo, 01141-020

  • Research Site

    São Paulo, 05403-000

Other trials in Brazil

Slovakia3 sites
  • Research Site

    Lučenec, 984 01

  • Research Site

    Martin, 036 01

  • Research Site

    Prešov, 080 01

Other trials in Slovakia

South Africa3 sites
  • Research Site

    Cape Town, 7405

  • Research Site

    Cape Town, 7500

  • Research Site

    Diepkloof, Soweto, 2013

Other trials in South Africa

South Korea3 sites
  • Research Site

    Gangwon-do, 26426

  • Research Site

    Seoul, 03080

  • Research Site

    Seoul, 03722

Other trials in South Korea

About this study

Official title: International, Multicentre, Parallel-group, Randomised, Double-blind, Placebo-controlled, Phase III Study Evaluating the Effect of Dapagliflozin on Exercise Capacity in Heart Failure Patients With Reduced Ejection Fraction

International, Multicentre, Parallel-group, Randomised, Double-blind, Placebo-controlled, Phase III Study Evaluating the effect of Dapagliflozin on Exercise Capacity in Heart Failure Patients with Reduced Ejection Fraction (HFrEF)

Being tested
Dapagliflozin, Placebo

What participants receive

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

  • DapagliflozinDrug

    Tablets administered orally once daily. Treatment start within 24h after randomisation for 16 weeks.

  • PlaceboOther

    Tablets administered orally once daily. Treatment start within 24h after randomisation for 16 weeks.

Study groups in NCT03877237
Study groupRoleWhat they receive
DapagliflozinExperimentalGreen, diamond shaped, film coated tablets 10 mg administered orally, once daily
Receives: Drug: Dapagliflozin
PlaceboPlacebo comparatorGreen, diamond shaped, film coated tablets placebo administered orally, once daily
Receives: Other: Placebo

What is being measured

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

  1. Change From Baseline in Kansas-City Cardiomyopathy Questionnaire-Total Symptom Score (KCCQ-TSS) at Week 16 (Higher Scores Represent Less HF Symptom Frequency and Burden).

    Change from baseline in KCCQ-TSS was defined as the endpoint value at week 16 minus the baseline value. 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. The KCCQ-TSS incorporates the symptom frequency (4 items) and symptom burden (3 items) domains into a single summary score. The score is transformed to a range of 0-100, in which a higher score reflects better health status. Baseline value is the last value on or prior to the randomization visit. Deaths are treated as the worst outcome and ordering among deaths is based on last value while alive. In rank ANCOVA and HL estimation, multiple imputation was performed on missing values for participants who were alive at the visit at week 16 but did not have KCCQ-TSS values.

    Measured: At baseline and at week 16 or death before week 16

  2. Change From Baseline in Kansas-City Cardiomyopathy Questionnaire-Physical Limitation Score (KCCQ-PLS) at Week 16 (Higher Scores Represent Less Physical Limitation Due to HF)

    Change from baseline in KCCQ-PLS was defined as the endpoint value at week 16 minus the baseline value. 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. The KCCQ-PLS incorporates the 6 physical limitation items into a single score. The score is transformed to a range of 0-100, in which a higher score reflects better health status. Baseline value is the last value on or prior to the randomization visit. Deaths are treated as the worst outcome and ordering among deaths is based on last value while alive. Deaths are treated as the worst outcome and ordering among deaths is based on last value while alive. In rank ANCOVA and HL estimation, multiple imputation was performed on missing values for participants who were alive at the visit at week 16 but did not have KCCQ-PLS values.

    Measured: At baseline and at week 16 or death before week 16

  3. Change From Baseline in 6-minute Walk Distance (6MWD) at Week 16 (Larger Distances Represent Better Functional Capacity).

    Change from baseline in 6-minute walk distance (6MWD) (exercise capacity) at week 16 was defined as the distance walked in 6 minutes at week 16 minus the baseline value. Baseline value is the last value on or prior to the randomization visit. Deaths are treated as the worst outcome and ordering among deaths is based on last value while alive. In rank ANCOVA and HL estimation, multiple imputation was performed on missing values for participants who were alive at the visit at week 16 but did not have 6MWD values.

    Measured: At baseline and at week 16 or death prior to week 16

Secondary outcomes (1)
  1. Change From Baseline at the End of the Study in the Total Time Spent in Light to Vigorous Physical Activity, as Assessed Using a Wearable Activity Monitor (Accelerometer).

    Change from baseline at the end of the study in total time spent in light to vigorous physical activity (LVPA), as assessed using a wearable activity monitor, was defined as the total time [per day] spent in LVPA at the end of the study minus the baseline value. Baseline is the 7 day period starting on the day of enrolment and ending before randomization. End of study is defined as the period starting on the day of week 14 and prior to the week 16 visit. Deaths are treated as the worst outcome and ordering among deaths is based on last value while alive.

    Measured: At baseline and at end of study or death before week 16.

Timeline

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

  1. First posted15 Mar 2019
  2. Study start9 Apr 2019
  3. Primary completion7 Mar 2020
  4. Study completion7 Mar 2020

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 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Triple blind
Who is masked
Participant, Care provider, Investigator
Enrolment
313 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03877237
Sponsor's protocol ID
D169EC00002
Other IDs
2018-003442-16, 2018
Status last verified
Apr 2021
First submitted
21 Feb 2019
Last updated
5 May 2021
Data monitoring committee
No
FDA-regulated drug
Yes
FDA-regulated device
No

Publications

  • Docherty KF, Buendia Lopez R, Folkvaljon F, Boer RA, Chen J, Hammarstedt A, Kitzman DW, Kosiborod MN, Langkilde AM, Reicher B, Senni M, Wilderang U, Verma S, Cowie MR, Solomon SD, McMurray JJV. Wearable Accelerometer-Derived Measures of Physical Activity in Heart Failure: Insights From the DETERMINE trials. J Card Fail. 2025 Apr;31(4):689-703. doi: 10.1016/j.cardfail.2024.10.439. Epub 2024 Nov 26.

    PubMed 39603408
  • Docherty KF, Buendia Lopez R, Folkvaljon F, de Boer RA, Cowie MR, Hammarstedt A, Kitzman DW, Kosiborod MN, Langkilde AM, Reicher B, Senni M, Shah SJ, Verma S, Solomon SD, McMurray JJV. Effect of Dapagliflozin on Accelerometer-Based Measures of Physical Activity in Patients With Heart Failure: An Analysis of the DETERMINE Trials. Circ Heart Fail. 2024 Oct;17(10):e012349. doi: 10.1161/CIRCHEARTFAILURE.124.012349. Epub 2024 Aug 30.

    PubMed 39212948
  • McMurray JJV, Docherty KF, de Boer RA, Hammarstedt A, Kitzman DW, Kosiborod MN, Maria Langkilde A, Reicher B, Senni M, Shah SJ, Wilderang U, Verma S, Solomon SD. Effect of Dapagliflozin Versus Placebo on Symptoms and 6-Minute Walk Distance in Patients With Heart Failure: The DETERMINE Randomized Clinical Trials. Circulation. 2024 Mar 12;149(11):825-838. doi: 10.1161/CIRCULATIONAHA.123.065061. Epub 2023 Dec 7.

    PubMed 38059368

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Dapagliflozin in people with Heart Failure With Reduced Ejection Fraction (HFrEF), run by AstraZeneca at 76 sites in 9 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 10 inclusion and 13 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: finished, as of the sponsor's last update on 5 May 2021. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 76 sites in United States, Canada, Denmark, Japan, Sweden and 4 more countries. 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. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 5 May 2021). 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?

Change From Baseline in Kansas-City Cardiomyopathy Questionnaire-Total Symptom Score (KCCQ-TSS) at Week 16 (Higher Scores Represent Less HF Symptom Frequency and Burden). (time frame: At baseline and at week 16 or death before week 16). The study lists 3 primary outcomes in all. 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 NCT03877237, 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 5 May 2021.

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