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.
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