The Heart Failure Optimization Study (HF-OPT): rationale and design.

Abstract

According to the current guidelines, implantable cardioverter-defibrillators (ICD) for primary prevention in patients with heart failure and reduced ejection fraction (HFrEF) should not be considered until optimal guideline-directed medical therapy (GDMT) has been achieved for aminimum of 3months. Optimization of GDMT often needs time beyond 3months after diagnosis. The aim of the Heart Failure Optimization Study (HF-OPT) is to evaluate the recovery of left ventricular function beyond 3months after diagnosis of newly diagnosed HFrEF. The HF-OPT multicenter study is comprised of two non-randomized phases (registry and study). During the first 90days awearable cardioverter-defibrillator (WCD) is prescribed and patients are enrolled in an observational pre-study registry. Registry subjects meeting inclusion criteria for the study portion at day90 have ongoing left ventricular ejection fraction (LVEF) reassessment at 90, 180 and 360 days after the index hospital discharge, regardless of continued WCD use. Approximately 600 subjects will be enrolled in the study portion. Of those, one-third are anticipated to start the study phase at day90 with reduced LVEF. The primary objective of this study is to observe the rate of recovery of LVEF > 35% between90 and 180days, while key secondary endpoints include mortality and WCD recorded arrhythmias and shocks. The HF-OPT study will provide important information on the rate of additional recovery of LVEF > 35%, between90 and 180days, in newly diagnosed HF with reduced LVEF patients being titrated with GDMT. The results of the study may impact indications for primary prophylactic ICD implantation.