[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"health-studies-list:{\"conditionNormalized\":\"heart-failure-and-reduced-ejection-fraction\",\"overallStatus\":[\"RECRUITING\",\"AVAILABLE\",\"NOT_YET_RECRUITING\"],\"orderBy\":\"LastUpdateSubmitDate:desc\",\"size\":25,\"offset\":0}":3,"health-study-condition:heart-failure-and-reduced-ejection-fraction":28},{"pageToken":4,"total":5,"offset":6,"count":5,"results":7},null,12,0,[8,47,80,110,133,155,185,208,237,269,298,323],{"id":9,"slug":10,"hasResults":11,"nctId":12,"briefTitle":13,"officialTitle":13,"acronym":14,"eligibilityCriteria":15,"healthyVolunteers":11,"sex":16,"minAge":17,"maxAge":4,"enrollmentInfo":18,"targetDuration":4,"studyType":21,"phases":22,"briefSummary":24,"conditions":25,"keywords":30,"overallStatus":34,"whyStopped":4,"lastUpdateSubmitDate":35,"lastUpdatePostDateStruct":36,"startDateStruct":39,"completionDateStruct":41,"leadSponsor":43,"locationsCount":46},"100628901","infusing-needed-iron-to-target-insufficiency-in-adults-treated-for-evidence-of-heart-failure-100628901",false,"NCT07467668","Infusing Needed Iron to Target Insufficiency in Adults Treated for Evidence of Heart Failure","INITIATE-HF","Inclusion Criteria:\n\nAdults (age \\>18 years); Diagnosed heart failure with most recent left ventricular ejection fraction \\\u003C50%; Hospitalized for any reason for the index admission; Documented iron deficiency defined as TSAT \\\u003C20% during the index hospitalization; At least 6 months of health plan coverage and prescription drug benefit before admission\n\nExclusion Criteria:\n\nA documented allergy to IV iron in the Kaiser Permanente Northern California (KPNC) electronic health record (EHR) system; A history of hemochromatosis (i.e., iron overload) based on KPNC EHR data; End-stage kidney disease (defined as receiving chronic dialysis or a prior kidney transplant) or advanced chronic kidney disease (i.e., estimated glomerular filtration rate \\[eGFR\\] \\\u003C30 mL\u002Fmin\u002F1.73 m2) based on most recent pre-admission outpatient laboratory results or the KPNC regional End-Stage Kidney Disease Treatment Registry; Serum ferritin \\>300 ng\u002FmL based on KPNC EHR data; Diagnosed with metastatic cancer and\u002For receiving systemic chemotherapy based on KPNC EHR data; Institutionalized (e.g., prison) and\u002For receiving palliative care per KPNC EHR data","ALL","18 Years",{"count":19,"type":20},3000,"ESTIMATED","INTERVENTIONAL",[23],"NA","The INITIATE-HF study is a cluster randomized controlled trial that aims to find out if reminding doctors about treatment guidelines for iron deficiency in adults with heart failure who are hospitalized and have evidence of iron deficiency changes the subsequent use of intravenous (IV) iron.\n\nTwo groups of hospitalized adult patients with known heart failure and iron deficiency will be compared:\n\n* Group 1 will include doctors who receive a notification with their patient's iron storage test results and guideline recommendations related to the use of IV iron.\n* Group 2 will include doctors who do not receive this notification and continue with usual standard of care.\n\nThe study will measure if this provider-facing notification affects physician use of recommended IV iron treatment in eligible patients with heart failure, left ventricular ejection fraction less than 50%, and iron deficiency. Secondarily, if there is an increased use of IV iron observed in the intervention group, this study will evaluate whether there are differential health outcomes (i.e., fewer subsequent hospital visits and lower risk of death) of patients whose providers were assigned to the intervention group.",[26,27,28,29],"Iron Deficiency (ID)","Heart Failure","Heart Failure and Reduced Ejection Fraction","Heart Failure and Mildly Reduced Ejection Fraction",[31,32,33],"IV iron","iron deficiency","heart failure","RECRUITING","2026-08-03",{"date":37,"type":38},"2026-08-05","ACTUAL",{"date":40,"type":38},"2026-04-20",{"date":42,"type":20},"2028-12-31",{"name":44,"class":45},"Kaiser Permanente","OTHER",1,{"id":48,"slug":49,"hasResults":11,"nctId":50,"briefTitle":51,"officialTitle":52,"acronym":53,"eligibilityCriteria":54,"healthyVolunteers":11,"sex":16,"minAge":17,"maxAge":4,"enrollmentInfo":55,"targetDuration":4,"studyType":21,"phases":57,"briefSummary":59,"conditions":60,"keywords":63,"overallStatus":71,"whyStopped":4,"lastUpdateSubmitDate":72,"lastUpdatePostDateStruct":73,"startDateStruct":74,"completionDateStruct":76,"leadSponsor":78,"locationsCount":4},"100649793","phase-3-evaluation-of-the-efficacy-and-safety-of-tirzepatide-a-dual-glp-1gip-agonist-on-functional-capacity-in-reduced-ejection-fraction-heart-failure-patients-with-obesity-100649793","NCT07738276","Evaluation of the Efficacy and Safety of Tirzepatide, a Dual GLP-1\u002FGIP Agonist, on Functional Capacity in Reduced Ejection Fraction Heart Failure Patients With Obesity","Evaluation of the Efficacy and Safety of Tirzepatide, a Dual GLP-1\u002FGIP Agonist, on Functional Capacity in Reduced Ejection Fraction Heart Failure Patients With Obesity: A Double-Blinded Randomized Controlled Trial","DUAL-HFrEF","Inclusion Criteria:\n\n* Age 18 years or older\n* Heart failure with reduced ejection fraction, defined as left ventricular ejection fraction ≤40% on echocardiography performed within the prior 3 months\n* Body mass index ≥27 kg\u002Fm², with at least one obesity-related comorbidity (hypertension, diabetes, or dyslipidemia)\n* Stable heart failure therapy for at least 4 weeks prior to enrollment, including beta-blockers, renin-angiotensin system inhibitors\u002Fangiotensin receptor-neprilysin inhibitors, and sodium-glucose cotransporter-2 inhibitors, if prescribed\n* Written informed consent\n\nExclusion Criteria:\n\n* Acute heart failure decompensation or cardiac hospitalization within the prior 4 weeks\n* Uncontrolled blood pressure (systolic blood pressure \\\u003C90 mmHg or ≥180 mmHg)\n* Advanced renal impairment (estimated glomerular filtration rate \\\u003C30 mL\u002Fmin\u002F1.73m²)\n* Severe hepatic impairment (liver enzymes elevated to 3 times the upper limit of normal)\n* Active pancreatitis\n* Personal or first-degree family history of medullary thyroid carcinoma or multiple endocrine neoplasia type 2\n* Pregnancy or breastfeeding\n* Known hypersensitivity to glucagon-like peptide-1 (GLP-1) or glucose-dependent insulinotropic polypeptide (GIP) receptor agonist drugs\n* Concurrent use of other weight-loss medications",{"count":56,"type":20},60,[58],"PHASE3","The goal of this clinical trial is to learn if tirzepatide works to improve physical function in adults with heart failure and obesity. It will also learn about the safety of tirzepatide. The main questions it aims to answer are:\n\nDoes tirzepatide improve how far participants can walk in 6 minutes? Does tirzepatide improve heart failure symptoms and quality of life? What side effects do participants have when taking tirzepatide?\n\nResearchers will compare tirzepatide to a placebo (a look-alike substance that contains no drug) to see if tirzepatide improves physical function in people with heart failure and obesity.\n\nParticipants will:\n\nGet a weekly injection of tirzepatide or a placebo under the skin for 6 months Start at a low dose, which may be raised slowly based on how well they tolerate it Keep taking their usual heart failure medicines Visit the clinic for checkups, blood tests, heart ultrasounds, and a 6-minute walk test Answer questions about their quality of life and heart failure symptoms",[28,61,62],"Obesity & Overweight","Tirzepatide",[62,64,65,66,67,68,69,70],"GLP-1\u002FGIP receptor agonist","Heart failure with reduced ejection fraction","Obesity","6-minute walk test","Weight loss","Functional capacity","Randomized controlled trial","NOT_YET_RECRUITING","2026-07-30",{"date":35,"type":38},{"date":75,"type":20},"2026-07-18",{"date":77,"type":20},"2027-12-22",{"name":79,"class":45},"Shahid Beheshti University of Medical Sciences",{"id":81,"slug":82,"hasResults":11,"nctId":83,"briefTitle":84,"officialTitle":84,"acronym":85,"eligibilityCriteria":86,"healthyVolunteers":11,"sex":16,"minAge":17,"maxAge":4,"enrollmentInfo":87,"targetDuration":4,"studyType":21,"phases":89,"briefSummary":90,"conditions":91,"keywords":95,"overallStatus":71,"whyStopped":4,"lastUpdateSubmitDate":100,"lastUpdatePostDateStruct":101,"startDateStruct":103,"completionDateStruct":105,"leadSponsor":107,"locationsCount":4},"100646212","relieve-hfref-trial-reducing-lung-congestion-symptoms-using-the-v-wave-shunt-in-advanced-heart-failure-with-reduced-ef-100646212","NCT07696975","RELIEVE-HFrEF TRIAL: REducing Lung congestIon Symptoms Using the v-wavE Shunt in adVancEd Heart Failure With Reduced EF","RELIEVE-HFrEF","Inclusion Criteria:\n\n1. Heart failure with a reduced LV ejection fraction (≤40%) and documented heart failure for at least 6 months from Baseline Visit.\n2. NYHA Class III symptoms\n3. Receiving guideline directed medical therapy (GDMT) for heart failure which refers to those HF drugs carrying a Class I indication:\n\n   1. An inhibitor of the renin-angiotensin system (RAS inhibitor), including an angiotensin receptor-neprilysin inhibitor (ARNI), angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) and an evidence-based beta-blocker (BB) for at least 3 months prior to the Baseline Visit\n   2. An SGLT2I Inhibitor for at least 1 month prior to the Baseline Visit\n   3. Other medications recommended for selected populations, e.g., on diuretics as required for volume control. Mineralocorticoid receptor antagonist (MRA) or nitrates\u002Fhydralazine should be used in appropriate patients, according to the published guidelines.\n   4. All patients are on stable HF medications as determined by the investigator, for at least 1 month, with the exception of diuretic therapy. Stable is defined as no more than a 100% increase or 50% decrease in dose within these periods.\n4. Receiving Class I recommended cardiac rhythm management device therapy. Specifically: if indicated by class I guidelines, cardiac resynchronization therapy (CRT), implanted cardioverter-defibrillator (ICD) or a pacemaker should be implanted at least 3 months prior to Baseline Visit.\n5. Must meet 5a OR 5b.\n\n   1. One (1) prior Heart Failure Hospitalization with duration \\>24 hours or Emergency Room Heart Failure Visit with duration ≥6 hours, or Heart Failure Clinic ADHF Visit with duration ≥6 hours, within 12 months from Baseline Visit.\n   2. Alternatively, if patients have not had a HF hospitalization or ER HF Visit within the prior 12 months, they must have a BMI corrected elevated Brain Natriuretic Peptide (BNP) level of at least 300 pg\u002Fml or an N-terminal pro-BNP (NT-proBNP) level of at least 1,500 pg\u002Fml, according to local measurement, within 3 months of the Baseline Visit.\n6. Able to perform the 6-minute walk test with a distance ≥100 meters and ≤450 meters.\n7. Provide written informed consent for study participation and be willing and able to comply with the required tests, treatment instructions and follow-up visits.\n\nMain Exclusion Criteria:\n\n* Resting systolic blood pressure \\\u003C90 or \\>160 mmHg\n* Baseline echocardiographic evidence of intracardiac blood clot, significant right ventricular dysfunction or severe left sided dilation.\n* Diagnosis of severe pulmonary hypertension.\n* Congenital Atrial septal defect, patent foramen ovale, with known shunting on echo\n* Untreated moderately severe or severe aortic or mitral stenosis.\n* Mitral valve repair device (e.g. MitraClip) implanted within 3 months prior to Baseline Visit.\n* Acute MI, acute coronary syndrome (ACS), percutaneous coronary intervention (PCI), rhythm management system revision (not including generator change), lead extraction, or cardiac or other major surgery within 3 months of Baseline Visit.\n* Stroke, transient ischemic attack (TIA), systemic or pulmonary thromboembolism, or deep vein thrombosis (DVT) within 6 months.\n* Intractable HF with any of the following:\n\nTreatment with IV vasoactive medications (e.g., IV inotropes, IV vasodilators) within the last 30 days.\n\nTreated with a ventricular assist device (VAD). Listed for cardiac transplantation.\n\n* Prior cardiac transplantation.\n* Life expectancy \\\u003C1 year due to non-cardiovascular illness.\n* Kidney failure or is receiving dialysis.\n* Active infection requiring parenteral or oral antibiotics.\n* Known allergy to nickel.\n* Hemodynamic, heart rhythm or respiratory instability at the time of Final Exclusion Criteria.",{"count":88,"type":20},250,[23],"This study will evaluate the V-Wave Ventura Interatrial shunt. The Shunt is a small, hourglass-shaped device implanted in the dividing wall (septum) between the right and left atria (top chambers) of the heart placed during a minimally invasive cardiac catheterization procedure. The hourglass shape of the device holds the Shunt in place. The small opening in the center allows a small amount of blood to flow (to be shunted) from the top left chamber to the top right chamber of the heart. By \"shunting\" this small amount of blood, the increased pressure in the left side of the heart is reduced, which is expected to reduce congestion in the lungs and improve your symptoms of heart failure.\n\nA previous study, the REducing Lung congestIon symptoms using the v-wavE shunt in adVancEd Heart Failure (RELIEVE-HF) trial showed that implantation of an interatrial shunt device was safe. In that study, patients whose heart pumping function (left ventricular ejection fraction, or LVEF) was \\>40% did not have better HF outcomes, such as hospitalization or even death after getting the device. However, the study looked separately at the LVEF ≤40% group and found that patients with an LVEF ≤40% showed improvements in these HF outcomes, as well as fewer episodes of worsening HF requiring an artificial heart pump. This suggests the shunt may help people whose heart pump is reduced, but more information is needed. The purpose of this study is to add to the data on the safety and whether the shunt works in preventing worsening heart failure for patients with reduced pumping strength or LVEF ≤40% .\n\nThis study is a multi-center, randomized, patient and observer blinded trial, with three (3) patients randomized to received the shunt (Treatment arm) for every two (2) non-implant Placebo-Procedure (Control patients). A total of approximately 250 patients will be randomized. Patients and research staff managing patients after randomization will be blinded during follow-up for a minimum of 12 months to a maximum of 24 months. All patients (Randomized to Treatment and Control) will be followed for a total of 3 years from the time of the randomization for comparison. Follow-up visits will be performed for the study will be conducted in clinic with the research doctors and staff and will include some telephone\u002Fremote visits. Patients randomized to the Control group who still meet inclusion\u002Fwithout exclusion criteria and consent will have an opportunity to receive the shunt if the effectiveness endpoint is met at primary study results.",[28,92,93,94],"Heart Failure Chronic","Heart Failure New York Heart Association Class III","Heart Failure Congestive",[27,96,97,98,99],"Chronic heart failure","Reduced LVEF","Heart failure with low EF","interatrial shunt","2026-07-08",{"date":102,"type":38},"2026-07-10",{"date":104,"type":20},"2026-09-30",{"date":106,"type":20},"2031-09-30",{"name":108,"class":109},"V-Wave Ltd","INDUSTRY",{"id":111,"slug":112,"hasResults":11,"nctId":113,"briefTitle":114,"officialTitle":115,"acronym":116,"eligibilityCriteria":117,"healthyVolunteers":11,"sex":16,"minAge":17,"maxAge":118,"enrollmentInfo":119,"targetDuration":121,"studyType":122,"phases":4,"briefSummary":123,"conditions":124,"keywords":4,"overallStatus":34,"whyStopped":4,"lastUpdateSubmitDate":100,"lastUpdatePostDateStruct":125,"startDateStruct":127,"completionDateStruct":129,"leadSponsor":131,"locationsCount":46},"100645637","biomarkers-for-left-ventricular-reverse-remodeling-in-heart-failure-revert-hf-100645637","NCT07701876","Biomarkers for Left Ventricular Reverse Remodeling in Heart Failure (REVERT-HF)","A Cohort Study of Advanced Heart Failure Based on Molecular Typing and Imaging Markers","REVERT-HF","Inclusion Criteria:\n\n1. Age ≥ 18 and ≤ 90 years at the time of signing informed consent.\n2. Diagnosed with symptomatic chronic heart failure with reduced ejection fraction (NYHA class II-IV) and has been on stable, optimized guideline-directed medical therapy and\u002For device therapy for at least 4 weeks.\n3. Left ventricular ejection fraction ≤ 40% assessed by echocardiography or cardiac MRI within 1 month prior to enrollment.\n\n   1. For patients who have undergone coronary revascularization (PCI or CABG), valve repair\u002Freplacement, cardiac resynchronization therapy (CRT), or other treatments that may improve LVEF (e.g., initiation of beta-blockers), LVEF must be reassessed at least 1 month after the intervention before enrollment.\n   2. If multiple LVEF measurements are available, the most recent one will be used for eligibility determination.\n4. NT-proBNP level measured at enrollment meeting at least one of the following criteria:\n\n   1. For LVEF 36%-40%: NT-proBNP ≥ 2500 pg\u002FmL (sinus rhythm) or ≥ 5000 pg\u002FmL (atrial fibrillation).\n   2. For LVEF 31%-35%: NT-proBNP ≥ 1000 pg\u002FmL (sinus rhythm) or ≥ 2000 pg\u002FmL (atrial fibrillation).\n   3. For LVEF ≤ 30%: NT-proBNP ≥ 600 pg\u002FmL (sinus rhythm) or ≥ 1200 pg\u002FmL (atrial fibrillation).\n   4. For patients rehospitalized for heart failure (LVEF ≤ 40% with heart failure hospitalization within the past 12 months): NT-proBNP ≥ 600 pg\u002FmL (sinus rhythm) or ≥ 1200 pg\u002FmL (atrial fibrillation).\n5. Receiving standard HFrEF medical therapy, unless contraindicated or intolerant, and stable for at least 4 weeks (excluding diuretic dose adjustments). The regimen should include, if applicable: ACE inhibitor, ARB, or sacubitril\u002Fvalsartan (ARNI) + beta-blocker + mineralocorticoid receptor antagonist (MRA) + SGLT2 inhibitor. Other agents such as vericiguat may be used with documentation.\n6. Estimated glomerular filtration rate (eGFR) ≥ 20 mL\u002Fmin\u002F1.73 m² (CKD-EPI) at enrollment.\n7. Willing and able to provide signed informed consent and comply with the requirements of the protocol.\n\nExclusion Criteria:\n\n1. Poor treatment adherence that may lead to worsening heart failure symptoms and signs due to non-compliance with prescribed medication.\n2. Systolic blood pressure \\\u003C 90 mmHg at enrollment or symptomatic hypotension within the past 24 hours.\n3. Myocardial infarction (defined by elevated cardiac enzymes with ischemic symptoms or new ischemic ECG changes), unstable angina, stroke, or transient ischemic attack (TIA) within 90 days prior to enrollment.\n4. Coronary revascularization (PCI\u002FCABG) or valve repair\u002Freplacement within 1 month prior to enrollment, or planned to undergo such procedures after enrollment.\n5. CRT implantation within 1 month prior to enrollment, or planned CRT implantation during the study period.\n6. Prior heart transplantation or ventricular assist device (VAD) implantation, or planned VAD implantation during the study period.\n7. History of specific cardiomyopathies, including restrictive cardiomyopathy, active myocarditis, constrictive pericarditis, hypertrophic obstructive cardiomyopathy, infiltrative cardiomyopathy (including but not limited to amyloidosis), familial or genetic cardiomyopathy, or arrhythmogenic right ventricular cardiomyopathy.\n8. Complex congenital heart disease or severe uncorrected primary valvular heart disease.\n9. Symptomatic bradycardia or second\u002Fthird-degree atrioventricular block without a pacemaker.\n10. Life expectancy \\\u003C 1 year due to non-cardiovascular causes (including but not limited to malignant tumors).\n11. Active malignancy or history of malignancy diagnosed within 2 years prior to screening, except for: (a) adequately treated basal cell carcinoma of the skin; (b) carcinoma in situ of the cervix; (c) low-risk prostate cancer (defined as PSA \\\u003C 10 ng\u002FmL, Gleason score ≤ 6, and clinical stage T1c or T2a prior to treatment).\n12. Alternative or concomitant diagnoses that could explain the participant's heart failure symptoms and signs (e.g., severe anemia, hypothyroidism, nephrotic syndrome).\n13. Primary pulmonary hypertension, chronic pulmonary embolism, or severe pulmonary disease (including COPD requiring home oxygen or frequent hospitalizations, or COPD exacerbation requiring invasive mechanical ventilation within 12 months prior to enrollment).\n14. Hepatic impairment: total bilirubin ≥ 1.5 × upper limit of normal (ULN), or ALT\u002FAST ≥ 3 × ULN (patients with Gilbert's syndrome and unconjugated hyperbilirubinemia with total bilirubin ≥ 1.5 × ULN but without other evidence of hepatic impairment may be enrolled).\n15. Known blood-borne infectious diseases.\n16. Severe or unstable kidney disease: eGFR \\\u003C 20 mL\u002Fmin\u002F1.73 m² (CKD-EPI) at randomization, rapidly deteriorating renal function, or requiring renal replacement therapy.\n17. Systolic blood pressure ≥ 160 mmHg (if on \\\u003C 3 antihypertensive agents) or ≥ 180 mmHg (regardless of treatment) at enrollment.\n18. Hemoglobin level \\\u003C 9 g\u002FdL.\n19. Major surgery (as judged by the investigator) within 90 days prior to enrollment, or planned major elective surgery within 90 days after screening.\n20. Paroxysmal or permanent atrial fibrillation excluded only if:\n\n    1. Requiring cardioversion (e.g., electrical cardioversion, atrial fibrillation ablation, or antiarrhythmic therapy) within ≤ 3 months prior to screening.\n    2. Heart rate not adequately controlled with anticoagulation therapy for at least 3 months prior to screening.\n21. Participation in another clinical trial and use of an investigational drug within 1 month prior to enrollment.\n22. Any other clinically significant disease, malignancy, active infection, condition, or disorder that, in the opinion of the investigator or medical monitor, may pose a safety risk to the participant or interfere with the evaluation, procedures, or completion of the study.","90 Years",{"count":120,"type":20},1740,"12 Months","OBSERVATIONAL","Heart failure is a serious condition where the heart cannot pump blood effectively. Some patients with severe heart failure (known as heart failure with reduced ejection fraction, or HFrEF) can experience significant improvement in their heart function after receiving guideline-directed medical therapy. This phenomenon is called heart failure with improved ejection fraction (HFimpEF). However, it is not fully understood why some patients improve while others do not.\n\nThis study aims to explore the molecular mechanisms behind this improvement by collecting blood samples and clinical data from patients with HFrEF in China. Participants will be followed for 12 months, and their heart function will be assessed at multiple time points. By analyzing blood biomarkers and imaging data, researchers hope to identify predictors of heart function improvement and develop a model to help personalize treatment for heart failure patients.\n\nThis is an observational study, meaning participants will receive their usual medical care and no experimental treatments or medications will be given. The study involves regular clinical visits and blood draws as part of routine care.",[27,28],{"date":126,"type":38},"2026-07-14",{"date":128,"type":38},"2025-11-01",{"date":130,"type":20},"2028-08-31",{"name":132,"class":45},"Ruijin Hospital Luwan Branch",{"id":134,"slug":135,"hasResults":11,"nctId":136,"briefTitle":137,"officialTitle":138,"acronym":4,"eligibilityCriteria":139,"healthyVolunteers":11,"sex":16,"minAge":17,"maxAge":4,"enrollmentInfo":140,"targetDuration":4,"studyType":21,"phases":142,"briefSummary":143,"conditions":144,"keywords":4,"overallStatus":71,"whyStopped":4,"lastUpdateSubmitDate":146,"lastUpdatePostDateStruct":147,"startDateStruct":149,"completionDateStruct":151,"leadSponsor":153,"locationsCount":4},"100646361","wearable-device-assisted-remote-management-to-improve-prognosis-in-patients-with-acute-heart-failure-complicated-by-atrial-fibrillation-warm-hf-trial-stage-2-100646361","NCT07687862","Wearable Device-Assisted Remote Management to Improve Prognosis in Patients With Acute Heart Failure Complicated by Atrial Fibrillation: WARM-HF Trial (Stage 2)","A Researcher-initiated, Prospective, Open-label, Randomized Controlled Trial With a Parallel Design to Investigate the Prognostic Impact of Wearable Device-assisted Remote Management in Patients With Acute Heart Failure Complicated by Atrial Fibrillation","Inclusion Criteria:\n\n1. Age ≥ 18 years;\n2. Subjects diagnosed with acute decompensated heart failure (ADHF) :\n\n1)Heart failure with reduced ejection fraction (HFrEF), defined as left ventricular ejection fraction (LVEF) ≤ 40%; 2)New York Heart Association (NYHA) functional class II-IV; 3)NT-proBNP \\> 2500 pg\u002FmL or BNP \\> 600 pg\u002FmL 3. Atrial fibrillation (AF) diagnosed during hospitalization (documented AF episode lasting \\> 30 seconds on electrocardiogram \\[ECG\\] within the past 12 months)\n\nExclusion Criteria:\n\n1. Intolerance to heart failure pharmacotherapy;\n2. Severe anemia or untreated thyroid disease;\n3. ST-segment elevation myocardial infarction within 3 months;\n4. Known complex congenital heart disease; infiltrative cardiomyopathy (such as cardiac amyloidosis, sarcoidosis, lymphoma, or endomyocardial fibrosis); myocarditis; constrictive pericarditis; cardiac tamponade; hypertrophic cardiomyopathy; stress cardiomyopathy; or uncorrected primary valvular heart disease requiring surgical interventions;\n5. Prior major cardiac surgery or mechanical circulatory support, or planned within 6 months, including coronary artery bypass grafting, cardiac valve repair or replacement, ventricular assist device or mechanical circulatory support device implantation, and heart transplantation;\n6. Existing pacemaker or planned pacemaker implantation;\n7. Contraindications to wearing a smartwatch (such as limb disability or known allergy to rubber\u002Fmetal materials);\n8. Inability to access the Internet or lack of proficiency in operating smart devices.",{"count":141,"type":20},818,[23],"With the advancement of wearable technology, continuous non-invasive monitoring of vital signs, arrhythmia burden, and physical status has become increasingly feasible. Devices such as smartwatches and electrocardiogram (ECG) straps can provide real-time physiological data, offering new opportunities for remote and proactive disease management. Despite the growing availability of such real-time data, the complex interaction between atrial fibrillation (AF) and heart failure (HF) necessitates highly personalized management. However, there remains a lack of high-quality clinical evidence on how to effectively integrate wearable device data into these personalized strategies for specific patient populations. Moreover, the prognostic impact of wearable device-assisted remote management has not been comprehensively evaluated. Therefore, robust clinical studies are needed to further evaluate whether wearable device-assisted remote monitoring can improve the long-term prognosis of this population after discharge from the cardiac care unit (CCU).\n\nIn this study (WARM-HF Stage 2), the investigators will conduct a prospective, multicenter, randomized controlled trial to determine whether wearable devices can reduce the composite endpoint of readmission or death in patients with HF.",[145,28],"Atrial Fibrillation (AF)","2026-07-07",{"date":148,"type":38},"2026-07-09",{"date":150,"type":20},"2026-09-01",{"date":152,"type":20},"2028-12-30",{"name":154,"class":45},"Beijing Anzhen Hospital",{"id":156,"slug":157,"hasResults":11,"nctId":158,"briefTitle":159,"officialTitle":160,"acronym":4,"eligibilityCriteria":161,"healthyVolunteers":11,"sex":16,"minAge":162,"maxAge":4,"enrollmentInfo":163,"targetDuration":4,"studyType":21,"phases":165,"briefSummary":166,"conditions":167,"keywords":168,"overallStatus":34,"whyStopped":4,"lastUpdateSubmitDate":175,"lastUpdatePostDateStruct":176,"startDateStruct":178,"completionDateStruct":180,"leadSponsor":182,"locationsCount":184},"100599411","developing-a-digital-aid-to-improve-icd-decisions-100599411","NCT07084142","Developing a Digital Aid to Improve ICD Decisions","Developing \"A Digital Shared Decision-Making Aid to Improve Patient-Centered Outcomes in Implantable Cardioverter-Defibrillator (ICD) Decisions Among Older Patients\"","Developmental Testing will attempt to abide by eligibility criteria identical to the planned criteria for the subsequent RCT, but may strategically deviate from these criteria to enhance the testing and development process.\n\nInclusion Criteria:\n\n* Meets or approximates minimal criteria for primary prevention ICD placement. ● Left Ventricular Ejection Fraction (LVEF) \\\u003C35%.\n* Clinical diagnosis of Heart Failure:\n* Patients with severe ischemic dilated cardiomyopathy and underlying NYHA\n* Class II or III Heart Failure, OR, Patients with severe nonischemic dilated cardiomyopathy and underlying NYHA Class II or III Heart Failure.\n* Age ≥ 70 years old.\n* Able to consent in English, Mandarin or Spanish and follow study instructions.\n\nExclusion Criteria:\n\nThe exclusion criteria include any of the following:\n\n* Past ICD implantation (not including pacemakers).\n* Any indication for secondary prevention of SCD via ICD implantation.\n* History of mechanical valve replacement.\n* History of recent myocardial infarction within the last 40 days.\n* History of recent revascularization within the past 90 days.\n* History of familial or genetic disorders with a high-risk of ventricular arrhythmias, such as the long QT syndrome (LQTS) or hypertrophic cardiomyopathy (HCM).\n* Any factors contraindicating ICD placement.\n* Less than 6 months life expectancy and other clinical consideration,\n* Unwilling or unable to consider ICD,\n* Any contraindications to ambulati","60 Years",{"count":164,"type":20},600,[23],"Advanced heart failure, affecting 7 million Americans, has multiple causes and results in greatly increased risk of disability and death. A major problem is sudden cardiac death, when the damaged heart develops an abnormal pattern of electrical conduction that can result in cessation of heart activity. While placement of an Implantable Cardioverter-Defibrillator (ICD) in a patient's chest can help prevent sudden cardiac death, these devices have several important downsides. This protocol focuses on development of a digital decision aid that helps heart failure patients make informed decisions that balance the benefits and downsides of ICD placement. This protocol covers the use of participant surveys, focus groups, and interviews to obtain the needed background information to guide the development of this digital tool, which will be subsequently tested against usual care in a randomized clinical trial. The study design is best described as a mixed methods evaluation and refinement of a digital app to improve ICD decision-making. In the future, the present protocol will be modified to create a new protocol that covers the needed human subjects requirements for performance of this clinical trial.",[28],[33,169,170,171,172,173,174],"HFrEF","sudden cardiac death","patient education","shared decision-making","arrhythmia","implantable cardioverter-defibrillator","2026-04-23",{"date":177,"type":38},"2026-04-27",{"date":179,"type":38},"2025-08-01",{"date":181,"type":20},"2028-02",{"name":183,"class":45},"Stanford University",2,{"id":186,"slug":187,"hasResults":11,"nctId":188,"briefTitle":189,"officialTitle":189,"acronym":190,"eligibilityCriteria":191,"healthyVolunteers":11,"sex":16,"minAge":17,"maxAge":4,"enrollmentInfo":192,"targetDuration":4,"studyType":21,"phases":194,"briefSummary":195,"conditions":196,"keywords":197,"overallStatus":71,"whyStopped":4,"lastUpdateSubmitDate":40,"lastUpdatePostDateStruct":201,"startDateStruct":202,"completionDateStruct":204,"leadSponsor":206,"locationsCount":4},"100635024","evaluation-of-accelerated-bachmann-bundle-area-pacing-in-heart-failure-with-reduced-ejection-fraction-who-have-electrocardiographic-evidence-of-interatrial-block-and-indicated-for-implantable-cardioverter-defibrillator-100635024","NCT07547306","Evaluation of Accelerated Bachmann Bundle Area Pacing in Heart Failure With Reduced ejectIon Fraction Who Have electrocarDioGraphic Evidence of Interatrial Block and Indicated for Implantable Cardioverter Defibrillator","BRIDGE-HF","Inclusion Criteria:\n\n1. Age ≥18 years at the time of screening.\n2. A documented diagnosis of chronic heart failure with New York Heart Association (NYHA) class II-IV.\n3. Left ventricular ejection fraction (LVEF) ≤40%, documented by an imaging study performed within 12 months prior to screening.\n4. Receiving optimized guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF), unless contraindicated or not tolerated:\n\n   * Participants receiving ongoing treatment must be on a stable regimen for at least 1 month prior to screening (except for diuretics).\n   * Most patients with heart failure require diuretics for volume control, and dose adjustments may be made based on clinical status, including symptoms, signs, and body weight. Each participant should receive individualized diuretic therapy to maintain optimal volume status.\n5. Presence of interatrial block (IAB), defined as a P-wave duration ≥120 ms on a 12-lead electrocardiogram or ECG recording device.\n6. An indication for dual-chamber implantable cardioverter-defibrillator (ICD) implantation for primary or secondary prevention.\n7. NT-proBNP measured within 3 months prior to randomization meeting one of the following criteria:\n\n   * NT-proBNP \\>300 pg\u002FmL\n\nExclusion Criteria:\n\n1. Non-paroxysmal AF.\n2. Uncontrolled tachyarrhythmia.\n3. Sinus bradycardia requiring continuous atrial pacing or atrioventricular block requiring ventricular pacing.\n4. Acute decompensated heart failure at the time of screening or hospitalization for worsening heart failure within 4 weeks prior to enrollment.\n5. Moderate to severe primary valvular heart disease (functional mitral regurgitation or tricuspid regurgitation is not an exclusion criterion).\n6. Prior mechanical tricuspid valve replacement.\n7. Coronary revascularization (PCI or CABG) or valve surgery\u002Frepair performed within 12 weeks prior to enrollment, or planned after randomization.\n8. Obstructive hypertrophic cardiomyopathy.\n9. Infiltrative cardiomyopathy, including but not limited to amyloidosis, sarcoidosis, or Fabry disease.\n10. An indication for cardiac resynchronization therapy (CRT).\n11. Chronic kidney disease, defined as an estimated glomerular filtration rate (eGFR) \\\u003C15 mL\u002Fmin\u002F1.73 m² calculated using the CKD-EPI equation.\n12. Chronic liver disease, defined as alanine aminotransferase (ALT), aspartate aminotransferase (AST), or alkaline phosphatase \\>3 times the upper limit of normal at screening.\n13. Severe pulmonary disease, such as cor pulmonale or irreversible lung disease requiring inhaled therapy or long-term oxygen therapy.\n14. Uncontrolled hypertension, defined as a mean blood pressure \\>140\u002F90 mmHg based on outpatient clinic measurements or home blood pressure recordings within the previous 30 days, or ongoing up-titration of antihypertensive medications.\n15. Pregnant or breastfeeding women, or women planning pregnancy or breastfeeding during the study period.\n16. Active malignancy requiring treatment at the time of screening.\n17. Life expectancy \\\u003C12 months.",{"count":193,"type":20},120,[23],"To evaluate the effect of accelerated atrial resynchronization achieved through Bachmann bundle pacing at the time of implantable cardioverter-defibrillator implantation in patients with heart failure with reduced ejection fraction and interatrial block",[28],[198,199,200],"heart failure and reduced ejection fraction","Bachmann bundle area pacing","interatrial block",{"date":175,"type":38},{"date":203,"type":20},"2026-05",{"date":205,"type":20},"2030-12-31",{"name":207,"class":45},"Seoul National University Hospital",{"id":209,"slug":210,"hasResults":11,"nctId":211,"briefTitle":212,"officialTitle":212,"acronym":213,"eligibilityCriteria":214,"healthyVolunteers":11,"sex":16,"minAge":17,"maxAge":4,"enrollmentInfo":215,"targetDuration":4,"studyType":21,"phases":217,"briefSummary":218,"conditions":219,"keywords":224,"overallStatus":34,"whyStopped":4,"lastUpdateSubmitDate":227,"lastUpdatePostDateStruct":228,"startDateStruct":230,"completionDateStruct":232,"leadSponsor":234,"locationsCount":236},"100634736","phase-3-selenium-intervention-registry-randomized-trial-in-heart-failure-100634736","NCT07543562","Selenium Intervention Registry Randomized Trial in Heart Failure","SIRI-HF","Inclusion Criteria:\n\nTo be considered for inclusion in this study, patients must meet all of the following eligibility requirements:\n\n* 18 years of age\n* primary discharge diagnosis of HF coded as ICD-10: I50, as recorded in The SwedeHF registry\n* be able to provide documented informed consent by signing and dating the designated consent form.\n\nExclusion Criteria:\n\n* Not suitable in the opinion of the Investigator (for example due to severe or terminal comorbidity with poor prognosis, or characteristics, pregnancy etc.) that may interfere with adherence to trial protocol",{"count":216,"type":20},4326,[58],"Heart failure is a serious condition in which the heart is unable to pump blood effectively, and it remains a leading cause of hospitalization and death worldwide despite advances in treatment.\n\nSelenium is an essential micronutrient that plays an important role in cellular energy production, antioxidant defense, and overall cardiovascular function. Low selenium levels are common among patients with heart failure in Northern Europe, and observational studies have shown that selenium deficiency is associated with an increased risk of hospitalization and death. In cases of severe deficiency, such as in Keshan disease, heart dysfunction can be reversed with selenium supplementation, suggesting a potential causal relationship.\n\nHowever, it is not yet known whether selenium supplementation can improve clinical outcomes in patients with heart failure when added to standard medical therapy.\n\nThe SIRI-HF trial is a randomized, placebo-controlled study designed to evaluate whether daily supplementation with 200 micrograms of selenium, in addition to guideline-directed medical therapy, improves outcomes in patients with heart failure.\n\nThe primary endpoint is a composite of recurrent heart failure hospitalizations and cardiovascular death. Secondary endpoints include all-cause mortality, changes in symptoms and functional status, and safety outcomes.\n\nThis study will include patients from Sweden and Norway and aims to determine whether correcting selenium deficiency can improve prognosis in heart failure.",[27,28,29,220,221,222,223],"Heart Failure and Preserved Ejection Fraction","Selenium Supplementation","Selenium","Cognitive Functioning",[33,225,226,213],"selenium","RRCT","2026-04-15",{"date":229,"type":38},"2026-04-22",{"date":231,"type":38},"2026-04-01",{"date":233,"type":20},"2031-03",{"name":235,"class":45},"Skane University Hospital",11,{"id":238,"slug":239,"hasResults":11,"nctId":240,"briefTitle":241,"officialTitle":242,"acronym":243,"eligibilityCriteria":244,"healthyVolunteers":11,"sex":16,"minAge":17,"maxAge":4,"enrollmentInfo":245,"targetDuration":4,"studyType":122,"phases":4,"briefSummary":247,"conditions":248,"keywords":250,"overallStatus":34,"whyStopped":4,"lastUpdateSubmitDate":260,"lastUpdatePostDateStruct":261,"startDateStruct":263,"completionDateStruct":265,"leadSponsor":267,"locationsCount":46},"100609018","propensity-matched-study-of-cardiac-contractility-modulation-therapy-in-heart-failure-100609018","NCT07209098","Propensity-Matched Study of Cardiac Contractility Modulation Therapy in Heart Failure","Broaden Accessibility of Breakthrough Treatment for Heart Failure: A Prospective, Propensity-Matched CED to Access the Impact of Cardiac Contractility Modulation Therapy (CCM)","BRIGHTEN-HF","Inclusion Criteria\n\n1. Continuous representation in the database in the year prior to index.\n2. Age 18 or older will be enrolled in either the treatment or control arm of the study.\n3. NYHA III heart failure,\n4. Not receiving CRT\n5. EF 25 - 45%, inclusive.\n6. Remain symptomatic despite at least 3 months of optimized guideline-directed medical therapy (GDMT) as determined by the heart team prior to CCM implantation.\n\nExclusion Criteria\n\n1. Subject has had a prior heart transplant\n2. Subject with mechanical tricuspid valve.\n3. Subject has a left ventricular assist device (LVAD).",{"count":246,"type":20},4200,"The purpose of this prospective, multi-center, propensity-matched coverage with evidence development (CED) study is to assess the impact of cardiac contractility modulation (CCM) on mortality and heart failure hospitalizations in Medicare-eligible patients with heart failure who meet indications for CCM.",[28,249],"NYHA Class III Heart Failure",[251,252,253,254,255,256,257,258,259],"Heart failure","Reduced ejection fraction","Cardiac Contractility Modulation","CCM","NYHA III","Propensity Score Matching","All-Cause Mortality","Heart Failure Hospitalizations","CED","2026-03-23",{"date":262,"type":38},"2026-03-24",{"date":264,"type":38},"2025-11-18",{"date":266,"type":20},"2031-04",{"name":268,"class":109},"Impulse Dynamics",{"id":270,"slug":271,"hasResults":11,"nctId":272,"briefTitle":273,"officialTitle":274,"acronym":275,"eligibilityCriteria":276,"healthyVolunteers":11,"sex":16,"minAge":17,"maxAge":4,"enrollmentInfo":277,"targetDuration":4,"studyType":21,"phases":278,"briefSummary":279,"conditions":280,"keywords":282,"overallStatus":34,"whyStopped":4,"lastUpdateSubmitDate":289,"lastUpdatePostDateStruct":290,"startDateStruct":292,"completionDateStruct":294,"leadSponsor":296,"locationsCount":46},"100626047","comparing-three-types-of-specialist-pacemakers-to-improve-heart-function-and-reduce-rhythm-problems-in-heart-failure-100626047","NCT07430553","Comparing Three Types of Specialist Pacemakers to Improve Heart Function and Reduce Rhythm Problems in Heart Failure","Randomised Investigation of Physiological, Conventional and Optimised Resynchronisation Therapy in Heart Failure With Prolonged QRS Duration (RIPCORD-CRT)","RIPCORD-CRT","Inclusion Criteria:\n\nPatients referred\u002Fscheduled for a CRT procedure (new implant or upgrade) who have:\n\n* Symptomatic heart failure (NYHA II-IV)\n* Reduced ejection fraction (LVEF≤40%)\n* Prolonged QRS duration (≥130ms) and left bundle branch block ECG morphology or very prolonged QRS duration (\\>150ms) and non-left bundle branch block ECG\n* Optimal medical therapy for HF\n\nExclusion Criteria:\n\n* Unable to provide informed consent\n* \\\u003C18 years old\n* Pregnant patients (with female patients of childbearing age requiring a negative urine BHCG)",{"count":56,"type":20},[23],"The goal of this clinical trial is to find out which type of specialist pacemaker-known as cardiac resynchronisation therapy (CRT)-works best for people with heart failure and a delay in how the lower chambers of the heart beat together (called electrical dyssynchrony).\n\nThe main aims of the study are:\n\nTo compare the effects of conventional biventricular pacing (BVP), conduction system pacing (CSP) and left-bundle optimised CRT (LOT-CRT) on heart failure symptoms and heart rhythm problems over six months.\n\nTo explore how these pacing methods affect heart muscle strength, electrical activity, and overall heart function.\n\nParticipants will:\n\nAttend four hospital visits over a six-month period.\n\nAt Visit 1, meet a member of the research team to discuss the study and have screening tests to check eligibility. Participants will also have a smartphone app installed and receive training on how to record their daily heart failure symptoms.\n\nAt Visit 2, have a CRT pacemaker implanted. The type of pacemaker will be chosen at random, with a 1 in 3 chance of receiving:\n\n* Biventricular pacing (BVP); the current standard treatment\n* Conduction system pacing (CSP)\n* LOT-CRT (Left-bundle optimised CRT); a combination of both\n\nAt Visit 3 (around 12 weeks after implantation) and Visit 4 (6 months after implantation), take part in routine follow-up assessments to check the pacemaker and heart function.\n\nAt Visits 2 and 4, also undergo non-invasive electrical mapping tests, including wearing a specialised vest and having a low-dose CT scan of the chest. These tests help researchers understand how the heart's electrical system responds to different pacing methods.",[28,281],"Dyssynchrony",[283,284,285,286,33,287,288],"Cardiac resynchronisation therapy","Conduction system pacing","optimised CRT","LOT-CRT","dyssynchrony","left bundle branch pacing","2026-02-17",{"date":291,"type":38},"2026-02-24",{"date":293,"type":38},"2025-11-12",{"date":295,"type":20},"2028-10-24",{"name":297,"class":45},"Imperial College London",{"id":299,"slug":300,"hasResults":11,"nctId":301,"briefTitle":302,"officialTitle":302,"acronym":303,"eligibilityCriteria":304,"healthyVolunteers":11,"sex":16,"minAge":17,"maxAge":4,"enrollmentInfo":305,"targetDuration":4,"studyType":122,"phases":4,"briefSummary":307,"conditions":308,"keywords":310,"overallStatus":34,"whyStopped":4,"lastUpdateSubmitDate":313,"lastUpdatePostDateStruct":314,"startDateStruct":316,"completionDateStruct":318,"leadSponsor":320,"locationsCount":322},"100603062","secondary-mitral-regurgitation-treatment-with-mitraclip-and-assessment-by-cardiac-magnetic-resonance-100603062","NCT07131631","Secondary Mitral Regurgitation Treatment With MitraClip and Assessment by Cardiac Magnetic Resonance","SMARTER-CMR","Inclusion Criteria:\n\n1\\. Adult patients (≥ 18 years old) with heart failure and reduced ejection fraction (LVEF \\\u003C 50% defined by echocardiography), medically and device-optimized according to guidelines, with significant FMR undergoing TEER with FDA-approved MitraClip device (Abbott Structural, USA)\n\nExclusion Criteria:\n\n1. Concomitant PCI and TEER\n2. Congenital heart disease\n3. Stage D heart failure\n4. Uncontrolled atrial fibrillation\n5. Pregnancy\n6. \\> moderate tricuspid regurgitation\n7. \\>moderate aortic regurgitation or stenosis\n8. Contraindications or unable to undergo CMR\n9. Prior mitral valve repair or replacement",{"count":306,"type":20},125,"This is a multi-center, prospective, observational study designed to evaluate the impact of LV myocardial fibrosis extent assessed by CMR on LV reverse remodeling and clinical outcomes post TEER. The target sample will be up to 125 patients enrolled to achieve 100 evaluable at 6 months of follow-up. Enrollment will occur at up to eight centers.",[28,309],"Functional Mitral Regurgitation",[33,311,312],"reduced ejection fraction","functional mitral regurgitation","2025-12-16",{"date":315,"type":38},"2025-12-23",{"date":317,"type":38},"2022-03-03",{"date":319,"type":20},"2027-07",{"name":321,"class":45},"Minneapolis Heart Institute Foundation",6,{"id":324,"slug":325,"hasResults":11,"nctId":326,"briefTitle":327,"officialTitle":328,"acronym":329,"eligibilityCriteria":330,"healthyVolunteers":11,"sex":16,"minAge":17,"maxAge":4,"enrollmentInfo":331,"targetDuration":4,"studyType":21,"phases":333,"briefSummary":334,"conditions":335,"keywords":336,"overallStatus":71,"whyStopped":4,"lastUpdateSubmitDate":339,"lastUpdatePostDateStruct":340,"startDateStruct":342,"completionDateStruct":343,"leadSponsor":345,"locationsCount":184},"100614118","effectiveness-and-safety-of-uptitration-of-guideline-directed-medical-therapy-in-heart-failure-with-reduced-ejection-fraction-with-limited-kidney-function-assessments-100614118","NCT07275437","Effectiveness and Safety of Uptitration of Guideline Directed MEdical Therapy in Heart Failure With Reduced Ejection Fraction With Limited Kidney Function Assessments","A Randomized, Controlled Trial Investigating the Effectiveness and Safety of Uptitration of Guideline Directed MEdical Therapy in Heart Failure With a Reduced Ejection Fraction With Limited Standardized Kidney Function Assessments (RESUME-HF-Kidney)","RESUME-HF","Inclusion Criteria:\n\n1. Able and willing to give written informed consent\n2. Age ≥ 18 years\n3. Diagnosed with HFrEF (LVEF≤ 45%) according to criteria from 2021 European Society of Cardiology guidelines for heart failure\n4. Less than 100% target dose of 2 individual reno-active GDMT classes (ACEi\u002FARB\u002FARNI, MRA or SGLT-2i)\n\nExclusion Criteria:\n\n1. eGFR\\\u003C25 mL\u002Fmin\u002F1.73 m2 measured up to 30 days before the first visit\n2. Potassium \\> 5.5 mmol\u002FL or \\\u003C3.5 mmol\u002FL at screening\n3. Known intolerance or allergy to two individual GDMT\n4. Signs of hemodynamic instability and\u002For cardiogenic shock\n5. Decompensated heart failure requiring treatment with intravenous loop diuretics\n6. Known concomitant structural kidney disease such as polycystic kidney disease or renal artery stenosis",{"count":332,"type":20},344,[23],"Guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) constitutes of four medications that substantially reduce morbidity and mortality, and improve quality of life. In routine clinical practice, various physician- and patient-related factors lead to suboptimal initiation and uptitration of GDMT to optimal dosing, which is associated with worse patient outcomes. A perceived major barrier to the optimalization of GDMT are changes in kidney function and electrolytes, which prompts physicians to halt uptitration, reduce doses, or even discontinue GDMT. Changes in kidney function and electrolytes during optimalization of GDMT are common, but not associated with adverse events.\n\nThe hypothesis of this study is that a reduction in the number of kidney function assessments during initiation and uptitration of GDMT in HFrEF patients will lead to higher achieved doses of GDMT without safety concerns.",[27,28,29],[337,338],"Guideline-Directed Medical Therapy","Limited Kidney Function Assessments","2025-12-10",{"date":341,"type":38},"2025-12-18",{"date":231,"type":20},{"date":344,"type":20},"2030-01-01",{"name":346,"class":45},"University Medical Center Groningen"]