STRONG-HF
Trial question
What is the role of up-titration of guideline-directed medical therapy in patients with acute HF?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
39.0% female
61.0% male
N = 1078
1078 patients (416 female, 662 male).
Inclusion criteria: patients aged 18-85 years admitted to hospital with acute HF, not treated with full doses of guideline-directed medical therapy.
Key exclusion criteria: age < 18 or > 85 years; intolerance to high doses of β-blockers and RAS blockers; mechanical ventilation in the 24 hours prior to screening.
Interventions
N=542 high-intensity care (rapid up-titration of guideline-directed drug treatments to 100% of recommended doses and close follow-up).
N=536 usual care (usual local practice).
Primary outcome
Readmission to hospital due to heart failure or death at day 180
15.2%
23.3%
23.3 %
17.5 %
11.7 %
5.8 %
0.0 %
High-intensity
care
Usual
care
Significant
decrease ▼
NNT = 12
Significant decrease in readmission to hospital due to HF or death at day 180 (15.2% vs. 23.3%; RR 0.66, 95% CI 0.5 to 0.86).
Secondary outcomes
Significantly greater increase in the EuroQol VAS at 12 months (10.72 points vs. 7.22 points; AD 3.49 points, 95% CI 1.74 to 5.24).
Significant increase in all-cause mortality at day 180 (8.5% vs. 10%; AD 1.6%, 95% CI 0.56 to 1.26).
Safety outcomes
No significant difference in serious adverse events and fatal adverse events.
Significant difference in adverse events by day 90 (41% vs. 29%).
Conclusion
In patients aged 18-85 years admitted to hospital with acute HF, not treated with full doses of guideline-directed medical therapy, high-intensity care was superior to usual care with respect to readmission to hospital due to HF or death at day 180.
Reference
Alexandre Mebazaa, Beth Davison, Ovidiu Chioncel et al. Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure (STRONG-HF): a multinational, open-label, randomised, trial. Lancet. 2022 Dec 3;400(10367):1938-1952.
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