Safety, tolerability, and efficacy of guideline-based augmentation of medical therapies in acute heart failure (STRONG-HF). multi-national, open, randomized, trial
There is little evidence for guideline-based dosing and titration rates of medical therapies after hospital admission for acute heart failure.
Between May 10, 2018 and September 23, 2022, 1,641 patients were screened, and 1,078 were successfully randomized to high-intensity care (n=542) or usual care (n=536; ITT population). Mean age was 63.0 years (SD 13.6), of 1078 patients, 416 (39%) were female, 662 (61%) were male, and 832 (77%) were white or Caucasian, 230 (21%) Black. , 12 (1%) were other races, one (<1%) Native American, and one (<1%) Pacific Islander (two [<1%] had missing data on race). The study was stopped early at the recommendation of the data and safety monitoring board due to larger than expected differences between the groups. By the end of the data (October 13, 2022), by day 90, a greater proportion of patients in the high-intensity care group had been titrated to full doses of prescribed medications (renin-angiotensin blockers 278). [55%] from 505 vs 11:00 [2%] from 497; β blockers 249 [49%] vs 20:00 [4%]; and mineralocorticoid receptor antagonists 423 [84%] vs 231: [46%]) at 90 days, blood pressure, pulse, New York Heart Association class, body weight, and NT-proBNP concentration decreased more in the high-intensity care group than in the usual care group. Heart failure readmission or all-cause death by day 180 occurred in 74 of 506 patients in the high-intensity care group (15.2% decrement weighted adjusted Kaplan-Meier estimate) and 109 of 502 patients (23.3%) : in the usual care group (adjusted risk difference 8.1% [95% CI 2·9–13·2]; p=0·0021; hazard ratio 0·66
[95% CI 0·50–0·86]) more adverse events occurred at 90 days in the high-intensity care group (223 [41%] 542) than in the usual care group (158 [29%] 536), but similar incidence of serious adverse events (88 [16%] vs 92: [17%]) and fatal adverse events (25 [5%] vs 32:00 [6%]) were presented in each group.
An intensive treatment strategy of rapid guideline-directed drug titration and close follow-up after acute heart failure was readily accepted by patients because it reduced symptoms, improved quality of life, and reduced 180-day all-cause death or heart failure readmission compared with usual care.
#Safety #tolerability #efficacy #guidelinebased #augmentation #medical #therapies #acute #heart #failure #STRONGHF #multinational #open #randomized #trial