Titration of Medications After Acute Heart Failure Is Safe, Tolerated, and Effective Regardless of Risk (JACC Heart Failure September 2024)-Article: Titration of Medications After Acute Heart Failure Is Safe, Tolerated, and Effective Regardless of Risk

Article: Titration of Medications After Acute Heart Failure Is Safe, Tolerated, and Effective Regardless of Risk

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The STRONG-HF study investigated the safety, tolerability, and effectiveness of rapid uptitration of guideline-directed medical therapy (GDMT) in patients with acute heart failure (HF) across different risk profiles, as assessed by the MAGGIC HF risk score. The study included 1,078 patients who were randomized to either high-intensity care (HIC), involving rapid uptitration of treatments to recommended doses within two weeks of discharge and frequent follow-up, or usual care (UC). The primary endpoint was the incidence of all-cause death or first HF rehospitalization at 180 days.<br /><br />The results demonstrated that GDMT use at baseline was similar across different risk strata, but higher in the HIC group compared to the UC group following the intervention. The primary endpoint of all-cause death or HF rehospitalization was significantly lower in the HIC group across all risk categories. Specifically, the risk ratios for the primary endpoint were consistent across MAGGIC risk score tertiles (interaction nonsignificant), suggesting that HIC is effective regardless of initial risk profile. Adverse events were more frequent in the HIC group but did not differ significantly by risk strata.<br /><br />The analysis indicates that HIC led to better adherence to GDMT, reduced HF-related morbidity and mortality, and was generally safe and well-tolerated across all risk levels. This suggests that clinicians should not be deterred from rapidly optimizing GDMT even in higher-risk patients. The study supports the implementation of HIC in clinical practice to improve outcomes in acute HF, regardless of the patient's initial risk profile.<br /><br />In conclusion, the STRONG-HF trial findings advocate for the rapid initiation and uptitration of GDMT, demonstrating efficacy and safety across a spectrum of HF severity, and thus offering a robust framework applicable to diverse patient populations in clinical settings.

Keywords

STRONG-HF study

acute heart failure

GDMT

rapid uptitration

high-intensity care

MAGGIC HF risk score

all-cause death

HF rehospitalization

clinical practice

patient outcomes