TY - JOUR
TI - Uptitrating Treatment After Heart Failure Hospitalization Across the Spectrum of Left Ventricular Ejection Fraction
AU - Pagnesi, M.
AU - Metra, M.
AU - Cohen-Solal, A.
AU - Edwards, C.
AU - Adamo, M.
AU - Tomasoni, D.
AU - Lam, C.S.P.
AU - Chioncel, O.
AU - Diaz, R.
AU - Filippatos, G.
AU - Ponikowski, P.
AU - Sliwa, K.
AU - Voors, A.A.
AU - Kimmoun, A.
AU - Novosadova, M.
AU - Takagi, K.
AU - Barros, M.
AU - Damasceno, A.
AU - Saidu, H.
AU - Gayat, E.
AU - Pang, P.S.
AU - Celutkiene, J.
AU - Cotter, G.
AU - Mebazaa, A.
AU - Davison, B.
JO - Journal of the American College of Cardiology
PY - 2023
VL - 81
TODO - 22
SP - 2131-2144
PB - HANLEY & BELFUS-ELSEVIER INC
SN - 0735-1097, 1558-3597
TODO - 10.1016/j.jacc.2023.03.426
TODO - 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
TODO - 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
ER -