Τίτλος:
Uptitrating Treatment After Heart Failure Hospitalization Across the Spectrum of Left Ventricular Ejection Fraction
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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
Συγγραφείς:
Pagnesi, M.
Metra, M.
Cohen-Solal, A.
Edwards, C.
Adamo, M.
Tomasoni, D.
Lam, C.S.P.
Chioncel, O.
Diaz, R.
Filippatos, G.
Ponikowski, P.
Sliwa, K.
Voors, A.A.
Kimmoun, A.
Novosadova, M.
Takagi, K.
Barros, M.
Damasceno, A.
Saidu, H.
Gayat, E.
Pang, P.S.
Celutkiene, J.
Cotter, G.
Mebazaa, A.
Davison, B.
Περιοδικό:
Journal of the American College of Cardiology
Εκδότης:
HANLEY & BELFUS-ELSEVIER INC
Λέξεις-κλειδιά:
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
DOI:
10.1016/j.jacc.2023.03.426
