STRONG-HF (secondary analysis, medium- vs. low-dose)
Trial question
What is the role of medium-dose guideline-directed medical therapy in high-intensity care patients 2 weeks after discharge from an acute HF admission?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
37.0% female
63.0% male
N = 293
293 patients (107 female, 186 male).
Inclusion criteria: patients with acute HF who were not treated with optimal doses of guideline-directed medical therapy before and after discharge from an acute HF admission.
Key exclusion criteria: age < 18 or > 85 years; intolerance to high doses of β-blockers or RAS blockers; mechanical ventilation in the 24 hours prior to screening; significant pulmonary disease; primary right HF.
Interventions
N=254 medium-dose (≥ 50 to < 90% optimal doses of guideline-directed medical therapy).
N=39 low-dose (< 50% optimal doses of guideline-directed medical therapy).
Primary outcome
Rate of death or heart failure readmission by day 180
13.3%
18.9%
18.9 %
14.2 %
9.4 %
4.7 %
0.0 %
Medium-dose
Low-dose
Significant
decrease ▼
NNT = 17
Significant decrease in the rate of death or HF readmission by day 180 (13.3% vs. 18.9%; HR 0.84, 95% CI 0.41 to 1.71).
Secondary outcomes
Significant decrease in the rate of death by day 180 (6.6% vs. 9.4%; HR 0.58, 95% CI 0.25 to 1.34).
No significant difference in improvement in QoL at day 90, measured by the EuroQol-5 Dimension VAS (8.57 points vs. 7.01 points; MD 0.1, 95% CI -4.88 to 5.07).
Significant decrease in the rate of death or HF readmission by day 180 in all patients (16.6% vs. 22%; HR 0.83, 95% CI 0.61 to 1.14).
Safety outcomes
No significant differences in acute MI, cardiac failure.
Significant differences in adverse event (38.6% vs. 53.8%), serious adverse event (14.6% vs. 23.1%).
Conclusion
In patients with acute HF who were not treated with optimal doses of guideline-directed medical therapy before and after discharge from an acute HF admission, medium-dose was superior to low-dose with respect to the rate of death or HF readmission by day 180.
Reference
Gad Cotter, Benjamin Deniau, Beth Davison et al. Optimization of Evidence-Based Heart Failure Medications After an Acute Heart Failure Admission: A Secondary Analysis of the STRONG-HF Randomized Clinical Trial. JAMA Cardiol. 2024 Feb 1;9(2):114-124.
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