Comparing medications for older adults with stable angina and multiple chronic conditions

Is this trial a fit for you?

A plain-English reading of the study's rules. Only the study team can confirm whether you qualify.

What this trial studies

This trial evaluates the effectiveness and tolerability of standard anti-anginal treatments, specifically beta-blockers and calcium channel blockers, in older adults suffering from symptomatic Stable Ischemic Heart Disease (SIHD) and multiple chronic conditions. It is a single-blind, randomized trial that aims to improve symptoms, function, and quality of life over a 12-month period through four study visits that include interviews, a six-minute walk test, and medical record reviews. The study will also assess the safety and long-term effectiveness of these medications, providing valuable data to inform clinical practice and guidelines.

Why it matters

Who can join: the full rules

Inclusion Criteria:

OLDER ADULTS WITH SIHD AND MCC

* Age ≥65 years
* ≥ 2 Multiple Chronic Conditions as defined by Centers for Medicare and Medicaid Services (CMS)
* Diagnosis of Symptomatic Stable Ischemic Heart Disease with plans to initiate medical therapy identified by at least one of the following:

  1. positive non-invasive functional or anatomic testing suggestive of obstructive coronary artery disease
  2. coronary angiography with stenosis ≥70% in a coronary artery ≥2 mm in diameter or

     ≥50% stenosis of left main
  3. Invasive coronary angiography with positive physiologic testing in at least one vessel (FFR ≤ 0.80 or iFR ≤0.89)

CAREGIVERS

* Age ≥ 18 years
* Identified as caregiver of LIVEBETTER participant

Exclusion Criteria:

OLDER ADULTS WITH SIHD AND MCC

* Current taking (both) a beta-blocker AND a calcium channel blocker\*
* Contraindication to beta-blockers or calcium channel blockers including:

  1. significant hypotension
  2. high grade AV block
  3. severe symptomatic bradycardia
  4. severe obstructive lung disease
* Documented intolerance to beta-blockers or calcium channel blockers
* Probable or definite high-risk coronary artery disease including unrevascularized left main disease and/or unrevascularized multi-vessel disease including the proximal left anterior descending (LAD) artery with plans for immediate complete revascularization
* Plans for complete revascularization within 2 weeks
* Clear clinical indication for beta-blockers or calcium channel blockers that precludes dose adjustment or crossover:

  1. Diagnosis of acute coronary syndrome (ACS) with reduced ejection fraction within past year
  2. Heart failure with reduced ejection fraction (HFrEF) within past year
* Actively participating in another clinical trial involving an investigational medication or device
* Primary language other than English or Spanish
* Inability to complete follow-up (e.g. life expectancy \<12 months, impaired decision-making determined by validated instrument)
* Previously enrolled in LIVEBETTER
* Refused informed consent

CAREGIVERS

* Professional caregiver (i.e. not a relative or close friend of the participant)
* Primary language other than English or Spanish
* Inability to complete follow-up
* Previously enrolled in LIVEBETTER
* Refused informed consent

Where it's running

• Yale School of Medicine
  New Haven, Connecticut, United States Recruiting
• Wellstar Research Institute
  Marietta, Georgia, United States Recruiting
• Cook County Health
  Chicago, Illinois, United States Recruiting
• Brigham and Women's Hospital
  Boston, Massachusetts, United States Recruiting
• Mt. Sinai Health System
  New York, New York, United States Recruiting
• Nirvana Integrative Medicine
  New York, New York, United States Recruiting

Study contacts

• Principal investigator: Michael Nanna, MD — Yale University
• Study coordinator: Michael Nanna, MD
• Email: livebetter-trial@yale.edu
• Phone: (888) 683-0865

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How to take part

1. Review the eligibility criteria above with your treating physician.
2. Check the official listing on ClinicalTrials.gov for the latest contact details and recruitment status.
3. Contact the study coordinator or principal investigator to ask for pre-screening. Pre-screening is free and never obligates you to enroll.