@article{3339456,
    title = "Uptitrating Treatment After Heart Failure Hospitalization Across the Spectrum of Left Ventricular Ejection Fraction",
    author = "Pagnesi, M. and Metra, M. and Cohen-Solal, A. and Edwards, C. and Adamo, M. and Tomasoni, D. and Lam, C.S.P. and Chioncel, O. and Diaz, R. and Filippatos, G. and Ponikowski, P. and Sliwa, K. and Voors, A.A. and Kimmoun, A. and Novosadova, M. and Takagi, K. and Barros, M. and Damasceno, A. and Saidu, H. and Gayat, E. and Pang, P.S. and Celutkiene, J. and Cotter, G. and Mebazaa, A. and Davison, B.",
    journal = "Journal of the American College of Cardiology",
    year = "2023",
    volume = "81",
    number = "22",
    pages = "2131-2144",
    publisher = "HANLEY & BELFUS-ELSEVIER INC",
    issn = "0735-1097, 1558-3597",
    doi = "10.1016/j.jacc.2023.03.426",
    keywords = "angiotensin receptor antagonist;  beta adrenergic receptor blocking agent;  enkephalinase inhibitor;  furosemide;  insulin;  loop diuretic agent;  mineralocorticoid antagonist;  renin inhibitor;  antihypertensive agent;  proteinase inhibitor, adult;  aged;  all cause mortality;  Article;  bradycardia;  cardiac resynchronization therapy;  clinical outcome;  comparative effectiveness;  controlled study;  diabetes mellitus;  drug dose titration;  European Quality of Life 5 Dimensions questionnaire;  female;  follow up;  heart failure;  heart left ventricle ejection fraction;  hospital readmission;  hospitalization;  human;  human cell;  intermethod comparison;  major clinical study;  male;  middle aged;  outcome assessment;  risk reduction;  vital sign;  heart failure;  heart left ventricle function;  heart stroke volume;  hospitalization;  randomized controlled trial, Antihypertensive Agents;  Heart Failure;  Hospitalization;  Humans;  Patient Readmission;  Protease Inhibitors;  Stroke Volume;  Ventricular Function, Left",
    abstract = "Background: Acute heart failure (AHF) is associated with a poor prognosis regardless of left ventricular ejection fraction (LVEF). STRONG-HF showed the efficacy and safety of a strategy of rapid uptitration of oral treatment for heart failure (HF) and close follow-up (high-intensity care), compared with usual care, in patients recently hospitalized for AHF and enrolled independently from their LVEF. Objectives: In this study, we sought to assess the impact of baseline LVEF on the effects of high-intensity care vs usual care in STRONG-HF. Methods: The STRONG-HF trial enrolled patients hospitalized for AHF with any LVEF and not treated with full doses of renin-angiotensin inhibitors, beta-blockers, and mineralocorticoid receptor antagonists. High-intensity care with uptitration of oral medications was performed independently from LVEF. The primary endpoint was the composite of HF rehospitalization or all-cause death at day 180. Results: Among the 1,078 patients randomized, 731 (68%) had LVEF ≤40% and 347 (32%) had LVEF >40%. The treatment benefit of high-intensity care vs usual care on the primary endpoint was consistent across the whole LVEF spectrum (interaction P with LVEF as a continuous variable = 0.372). Mean difference in the EQ-5D visual analog scale change from baseline to day 90 between treatment arms was slightly greater at higher LVEF values, but with no interaction between LVEF as a continuous variable and the treatment strategy (interaction P = 0.358). Serious adverse events were also independent from LVEF. Conclusions: Rapid uptitration of oral medications for HF and close follow-up reduce 180-day death and HF rehospitalization after AHF hospitalization independently from LVEF. (Safety, Tolerability and Efficacy of Rapid Optimization, Helped by NT-ProBNP Testing, of Heart Failure Therapies [STRONG-HF]; NCT03412201) © 2023"
}