Among acute HF patients receiving high-intensity care in the STRONG-HF trial, the occurrence of any safety indicator was associated with lower achieved doses of GDMT, but this did not affect the risk of 180-day HF readmission or all-cause mortality.

This summary is based on the publication of Tomasoni D et al. - Safety Indicators in Patients Receiving High-intensity Care After Hospital Admission for Acute Heart Failure: The STRONG-HF Trial. J Card Fail. 2023 Oct 9:S1071-9164(23)00342-1. doi: 10.1016/j.cardfail.2023.09.002.

Introduction and methods

Background and aim of the study

In the STRONG-HF trial, it was shown that a high-intensity care strategy of rapid uptitration of GDMT and close follow-up reduced the risk of 180-day HF rehospitalization or all-cause mortality in patients hospitalized for acute HF compared with usual care [1-2]. The aim of this subanalysis of the STRONG-HF trial was to investigate how safety indicators affect achieved doses of GDMT and clinical outcomes in patients receiving high-intensity care after hospitalization for acute HF.

Methods

The STRONG-HF trial was a multicenter, open-label trial in which patients with acute HF were randomized before discharge to a high-intensity care strategy of early up-titration of GDMT or usual care. In the high-intensity care arm (n=542), GDMT therapy (β-blockers, ACEi/ARBs/ARNI, or MRAs) was rapidly up-titrated to 50% of optimal doses within 2 days before anticipated discharge and to 100% of the optimal doses within 2 weeks after discharge. Patients had follow-up visits at week 1, 2, 3, and 6, and an additional safety visit 1 week after any up-titration. GDMT up-titration was delayed if prespecified safety indicators were present. These safety indicators included: eGFR of<30 mL/min/1.73 m² (n=28), serum potassium level of <5.0 mmol/L (n=149), SBP of >95 mmHg (n=51), heart rate of <55 bpm (n=46), and NT-proBNP of >10% higher than the value at randomization (n=223). Patients of the high-intensity care strategy were stratified into 2 groups based on the occurrence of any safety indicator at week 1, 2, 3 or 6.

Outcomes

The primary outcome of STRONG-HF was the composite of all-cause mortality or first HF rehospitalization at day 180.

Main results

• A total of 229 patients (42.3%) had no safety indicator and 313 patients (57.7%) had ≥1 safety indicator at any follow-up visit. Patients who had ≥1 safety indicator were less likely to have a history of HF, and more often had ACS, severe HF symptoms, higher NYHA class at month 1, and a lower SBP and higher heart rate at baseline compared with patients without any safety indicator.
• Lower percentages of optimal GDMT doses were achieved in patients with any safety indicator compared with patients without any safety indicator (mean difference: -11.0%; 95%CI: -13.6 to -8.4%; P<0.001). Differences between groups were evident from week 2.
• The primary composite outcome occurred in 43 patients (15.0%) with any safety indicator and in 31 patients (14.2%) without any safety indicator (HR: 0.84; 95%CI: 0.48-1.46; P=0.54). No single safety indicator was associated with the primary outcome.
• An eGFR of <30 mL/min/1.73 m² was associated with an increased risk of 180-day readmission for HF (adjusted HR: 3.60; 95%CI: 1.22-10.60; P=0.02).
• Patients with any safety indicator had smaller improvements in EQ-5D VAS score compared with patients without any safety indicator (adjusted difference: -3.32 points; 95%CI: -5.97 to -0.66; P=0.015).

Conclusion

References

Find this article online at J Card Fail.