The Minnesota Heart Failure Consortium: A Regional Clinical Center

描述(由申请人提供)： 明尼苏达心力衰竭联盟(MHFC)由明尼苏达大学心脏病学系的教职员工领导，由在大双城地区的10家诊所和医院执业的心脏病专家和护士组成。这些地点的患者包括所有严重程度的急性和慢性心力衰竭，以及广泛的人口结构组合。MHFC成立于2002年，拥有一名全职协调员，并在成功开展合作调查和教育活动方面建立了良好的记录。因此，领导力和基础设施已经到位，可以成为拟议网络中一个成功和富有成效的区域临床中心。RFA的研究建议包括：第一，一项新的研究，将以非利尿剂为基础的容量控制策略的临床和生物学影响与出现急性心力衰竭失代偿的患者的常规护理进行比较。这项研究将在住院期间启动，并持续3个月。在非利尿组中，超滤将被用来达到和维持血容量平衡。这项研究的主要终点是维持稳定的肾功能。次要目标包括描述许多临床和生物变量与出院后肾功能不全的发展之间的关系。因此，这项研究将解决利尿剂治疗对ADHF患者肾功能障碍发展的急性和慢性影响的几个重要问题，代表着不以环状利尿剂为基础的容量控制方案的首次慢性试验，并大大扩展关于ADHF患者临床病程中几个关键临床和生物变量行为的知识库。第二项拟议的研究涉及口服有效的选择性β-2肾上腺素能激动剂克伦特罗在中到重度但稳定的慢性心力衰竭患者中的首次测试。这项研究将评估瘦肉精对这一人群中几个临床和生物学变量的影响，瘦肉精是一种基于对终末期患者的初步经验的有前途的药物。因此，这些建议解决了及时的问题，代表了MHFC调查人员和现场已经获得相当经验的工作的合乎逻辑的延伸，有可能扩大我们对现有治疗策略的作用的了解，或者大幅增加关于有前途的新制剂的信息。解决这些问题的协议将具有适当的大小，以便研究所提议的网络所设想的大小的协议。(摘要结束)

DESCRIPTION (provided by applicant): The Minnesota Heart Failure Consortium (MHFC), led by faculty from the Division of Cardiology at the University of Minnesota, is comprised of cardiologists and nurses practicing at 10 clinics and hospitals in the greater Twin Cities area. Patient populations at these sites encompass both acute and chronic heart failure at all severity levels, and a wide demographic mix. The MHFC was formed in 2002, has a full time coordinator, and an established record of successful collaborative investigative and educational activity. Leadership and infrastructure are therefore in place to become a successful and productive Regional Clinical Center in the proposed network. Research proposals for the RFA include first a novel study in which the clinical and biological impact of a nondiuretic-based strategy of volume control will be compared with usual care in patients presenting with acute heart failure decompensation. The study will be initiated during hospital admission and continued for 3 months. Ultrafiltration will be used to achieve and maintain volume homeostasis in the nondiuretic group. The primary endpoint of this study is maintenance of stable renal function. Secondary goals include characterization of the relationship between numerous clinical and biological variables and the development of renal insufficiency in the post-discharge period. This study will therefore address several important questions regarding the acute and chronic impact of diuretic therapy on the development of renal dysfunction in patients with ADHF, represent the first chronic trial of a regimen for volume control not based on loop diuretics, and significantly expand the knowledge base regarding the behavior of several key clinical and biological variables on the clinical course of patients presenting with ADHF. The second proposed study involves the first test of the orally effective selective beta-2 adrenergic agonist clenbuterol in patients with moderate to severe, but stable chronic heart failure. The study will access the impact of clenbuterol, a promising agent based on preliminary experience in end-stage patients, on several clinical and biological variables in this population. These proposals therefore deal with timely questions, represent logical extensions of work with which MHFC investigators and sites have already obtained considerable experience, have the potential to either expand our knowledge of the role of existing treatment strategies or to substantially increase information regarding a promising new agent. Protocols to address these issues would be of suitable size for study in protocols of the size envisioned by the proposed network. (End of Abstract)