This proposal represents an application by the Mayo Clinic to be a REGIONAL CLINICAL CENTER (RCC) and a site for a CLINICAL RESEARCH SKILLS DEVELOPMENT CORE (SDC) in the Heart Failure Clinical Research Network (HFCRN). Mayo was a RCC and SDC site in the first funding period of the HFCRN. The Mayo RCC investigators designed and as serve as the principal investigator (PI) on two HFCRN trials (RELAX and ROSE) and three ancillary studies. We lead enrollment across the nine HFCRN sites. Our proposed protocol is POSE (Post-hospitalization Optimization Strategies Evaluation); a randomized, double- blind, placebo-controlled trial of subcutaneous (SQ) administration of BNP added to standard therapy at hospital dismissal and continued for 30 days in patients admitted for acute heart failure syndrome (AHFS). Hypothesis: As compared to placebo, therapy with SQ BNP will be associated with greater clinical stability at 60 days post discharge as assessed by a composite HF stability score. The long-term goal of POSE is to provide the rationale for a future adequately powered phase III study to test the impact of this strategy on HF readmissions. POSE is a small proof-of-concept study which tests a innovative therapeutic strategy at a novel AHFS therapeutic window extending the time course of therapeutic interventions in AHFS into the vulnerable post-discharge period to promote further clinical stabilization. POSE targets the appropriate AHFS subgroup based on the pathophysiology of AHFS and the biological actions of the proposed therapeutic and uses a novel, highly quantitative composite endpoint reflecting clinical stability. Finally, we document the successes of the MAYO HFCRN CLINICAL RESEARCH SKILLS DEVELOPMENT CORE (SDC) in the first cycle of funding and outline our continued strategy to train academic HF physician scientists in our Mayo SDC application.

Public Health Relevance

This proposal represents an application by the existing MAYO REGIONAL CLINICAL CENTER and MAYO CLINICAL RESEARCH SKILLS DEVELOPMENT CORE to participate in the Heart Failure Clinical Research Network. Mayo's participation will advance the goal of the Network which is to improve the treatment of HF by testing, through randomized clinical trials, interventions aiding in the management of HF and its morbidity.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Cooperative Clinical Research--Cooperative Agreements (U10)
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Special Emphasis Panel (ZHL1)
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Desvigne-Nickens, Patrice
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Mayo Clinic, Rochester
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Reddy, Yogesh N V; Olson, Thomas P; Obokata, Masaru et al. (2018) Hemodynamic Correlates and Diagnostic Role of Cardiopulmonary Exercise Testing in Heart Failure With Preserved Ejection Fraction. JACC Heart Fail 6:665-675
Obokata, Masaru; Borlaug, Barry A (2018) The strengths and limitations of E/e' in heart failure with preserved ejection fraction. Eur J Heart Fail 20:1312-1314
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Borlaug, Barry A (2018) Can Oxygen Transport Analysis Tell Us Why People With Heart Failure With Preserved Ejection Fraction Feel So Poorly? Circulation 137:162-165
Reddy, Yogesh N V; Obokata, Masaru; Gersh, Bernard J et al. (2018) High Prevalence of Occult Heart Failure With Preserved Ejection Fraction Among Patients With Atrial Fibrillation and Dyspnea. Circulation 137:534-535
Wolsk, Emil; Kaye, David; Borlaug, Barry A et al. (2018) Resting and exercise haemodynamics in relation to six-minute walk test in patients with heart failure and preserved ejection fraction. Eur J Heart Fail 20:715-722
Obokata, Masaru; Borlaug, Barry A (2018) Stress Imaging in Heart Failure: Physiologic, Diagnostic, and Therapeutic Insights. Circ Cardiovasc Imaging 11:e007785
Borlaug, Barry A; Anstrom, Kevin J; Lewis, Gregory D et al. (2018) Effect of Inorganic Nitrite vs Placebo on Exercise Capacity Among Patients With Heart Failure With Preserved Ejection Fraction: The INDIE-HFpEF Randomized Clinical Trial. JAMA 320:1764-1773
Egbe, Alexander C; Reddy, Yogesh N V; Khan, Arooj R et al. (2018) Venous congestion and pulmonary vascular function in Fontan circulation: Implications for prognosis and treatment. Int J Cardiol 271:312-316

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