|
|
| General |
| Study Status |
Ongoing |
Application Number /
Requirement Number |
P890003 S372/ PAS001 |
| Date Original Protocol Accepted |
09/01/2017
|
| Date Current Protocol Accepted |
|
| Study Name |
Heart Failure Risk Status (HFRS) PAS
|
| Device Name |
SYNERGYST II PULSE GENERATOR
|
| General Study Protocol Parameters |
| Study Design |
Prospective Cohort Study
|
| Data Source |
New Data Collection
|
| Comparison Group |
No Control
|
| Analysis Type |
Descriptive
|
| Study Population |
Adult: >21
|
| Detailed Study Protocol Parameters |
| Study Objectives |
To characterize clinical actions taken for each risk status as reported by HFRS report. The HFRS PAS is a US, prospective, observational, multi-center study
|
| Study Population |
The study population includes all patients meeting the indication for a Medtronic ICD or CRT device approved for commercial release with the OptiVol fluid monitoring feature who participate in Medtronic’s CareLink Network and consent to the study.
|
| Sample Size |
A sample size of 430 unique high risk transmissions will produce a two-sided 95% confidence interval with a width of less than 10% when the sample proportion is 65%, which was derived from the TRIAGE-HF study that worsening HF signs/symptoms were present in 65% of the High Risk Evaluations.
The HFRS PAS is designed to obtain a reliable estimate of the positive predictive value (PPV) of the HFRS High Status associated with worsening heart failure and to gain a better understanding of HF patient management practices. The HFRS PAS is based on several assumptions to estimate the timeframe needed to obtain a meaningful effective sample size for the parameter of interest including:
Number of eligible ICD/CRT system implants during the desired study duration
% of ICD/CRT patients who participate in Medtronic Carelink Network and transmit data through the network
Estimated number of transmissions/year/enrollment
% of transmissions with a HFRS High Risk Status
An estimated 2,000 patients implanted with an eligible device with a 60% CareLink participation rate and two transmissions per year will achieve the effective sample size for the parameter of interest within an estimated two-year period.
|
| Key Study Endpoints |
Primary endpoint:
The positive predictive value (PPV) of HFRS High Risk Status associated with worsening
heart failure.
A true positive will be defined as a high-risk status and reported patient signs/symptoms
Positive Predictive Value will be calculated by dividing the number of True Positive by all transmissions reviewed with a high-risk status
Secondary endpoints
The number of HF hospitalization or HF related deaths that were not preceded by a High Risk Status
The purpose of this objective is to report on false negatives. The study will collect data on all incidences of HF related hospitalization and/or death, and identify if transmission data for 30-day period prior to the incidence is available. A patient with a reported HF hospitalization and/or death with available transmission data for 30-day period prior to the date of the reported event with no High-Risk Triggers will be reported regardless of whether the transmission was reviewed by the site. Reported HF related hospitalization or death with no transmission data availability within 30 days of the event will not be included for this objective.
This is a post market observational study by design, there is no formal interim analysis defined. However, the study will continuously monitor the status of clinician behavior: the proportion of transmissions when HFRS is reviewed will be summarized periodically. In addition, HF related events and hospitalization rates will be monitored in reports.
|
| Follow-up Visits and Length of Follow-up |
Patients will be followed for a minimum of 12 months. The primary objective will be analyzed when the effective size of 430 patients with “High” risk trigger transmissions are collected or 3 years post-approval.
|
| Interim or Final Data Summary |
| Interim Results |
35 reported patient deaths, 8 HF-related.
|
| Actual Number of Patients Enrolled |
1018
|
| Actual Number of Sites Enrolled |
66
|
| Patient Follow-up Rate |
96.76% (985/1018). 33 missing CareLink Follow-Ups.
|
| Final Effect Findings |
230 high risk alerts (in 162 subjects), representing 3.3% of current contributing CareLink transmissions with a HFRS "High Risk Status".
72 site reported HF events, 67 have been adjudicated by CEC as HF-related, 3 are pending adjudication. Of the 67 adjudicated HF-related events, 40 were hospitalizations. Of the 40, 23 (23/40 = 57.5%, 23/67 = 34.3%) had a device transmission within the 30 days preceeding the event. Of the 23, 6 were high risk transmissions (6/23 = 26%, 6/40 = 15%, 6/67 = 9%).
35 patient deaths, 8 were HF-related. Of the 8, 5 had a device transmission within 30 days prior (5/8 = 62.5%) , with 1 being a high-risk alert (1/8 = 12.5%).
|
