Physicians' Academy for Cardiovascular Education

Rapid uptitration of HF medication with close follow-up benefits hospitalized AHF patients

News - Nov. 8, 2022

STRONG-HF: Successful Post-Discharge Management of Heart Failure

Presented at the AHA Scientific Sessions 2022 by: Alexandre Mebazaa, MD- Paris, France

Introduction and methods

After discharge following hospital admission for acute HF (AHF), patients should be followed up within 1–4 weeks, as recommended by the 2021 ESC Guidelines and 2022 ACC/AHA/HFSA guidelines. However, only few AHF patients are monitored or treated with full doses of HF medications. In the STRONG-HF (Safety, Tolerability and Efficacy of Rapid Optimization, Helped by NT-proBNP Testing, of Heart Failure Therapies) study, the efficacy and safety of rapid uptitration of oral HF therapies were therefore assessed.

In this RCT, 1800 AHF patients who were ready to be discharged from the hospital were scheduled for randomization to high-intensity care after discharge or usual care. Inclusion criteria were no or suboptimal doses of HF therapies and predischarge NT-proBNP >1500 pg/mL. Before discharge, patients in the high-intensity care arm received half of the optimal doses of 3 HF therapies (i.e., ACEi/ARB/ARNI plus beta-blocker plus MRA). At weeks 1, 2, 3, and 6, safety was assessed by clinical exam and laboratory testing (including NT-proBNP) in the high-intensity arm only. If there were no safety concerns at week 2, all 3 HF medications were uptitrated to the full optimal dose.

The primary endpoint was a composite outcome of HF hospital readmission or all-cause mortality after 180 days. The main secondary endpoint was patient’s quality of life as assessed with the EuroQol-5D (EQ-5D) visual analog scale (VAS). To evaluate safety, the incidence of treatment-emergent adverse events at day 90 was assessed.

On September 23, 2022, the study was terminated early by the Data and Safety Monitoring Board (at that time, 1069 patients were included) because of a larger than expected difference in the primary endpoint in favor of the high-intensity care group.

Main results

Conclusion

In the STRONG-HF trial, rapid uptitration of HF therapies with close follow-up of hospitalized AHF patients who were ready to be discharged was associated with a reduction of HF hospital readmission or all-cause mortality with usual care. This form of high-intensity care was safe and also improved patient’s quality of life.

- Our reporting is based on the information provided at the AHA Scientific Sessions -

The results of this study were simultaneously published in The Lancet . Watch a video by Prof. Mebazaa

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