Heart failure & cardiomyopathiesSecondary analysis
Early Changes in Renal Function During Rapid Up-Titration of Guideline-Directed Medical Therapy Following an Admission for Acute Heart Failure
- Secondary analysis of the STRONG-HF randomised trial
- subgroup analysis
Authors' conclusion
In the STRONG-HF study, HIC reduced 180-day HF readmission or death regardless of baseline eGFR. An early decrease in eGFR during rapid up-titration of GDMT was associated with more evidence of congestion, yet lower doses of GDMT during follow-up.
Study context
- Population
- Patients after admission for acute heart failure (HF) randomised to high-intensity care (HIC) with rapid up-titration of guideline-directed medical therapy (GDMT) in STRONG-HFHIC arm
- Participants
- 542 patients
- Comparison
- Early estimated glomerular filtration rate (eGFR) decrease vs no eGFR decrease during rapid GDMT up-titration
- eGFR decreasen = 77
- Primary endpoint
- Association of eGFR decrease (≥15% from baseline) at week 1 with clinical characteristics and outcomes
- Follow-up
- Week 1
Primary result
As reported in the abstract
HF readmission or death · 180 days
P = 0.2274
- eGFR decrease within 1 week
- 77 (15.5%)
Further findings
HF readmissions · 180 days
P = 0.0496
Geometrical mean
| Outcome | eGFR decrease | No eGFR decrease | P value |
|---|---|---|---|
| Change in NT-proBNP · smaller reductions with eGFR decrease | 1.12 | 0.81 | P = 0.0003 |
Congestion and GDMT doses after eGFR decrease
- More rales on examination with eGFR decrease
- P = 0.004
- Lower average optimal GDMT doses during follow-up after eGFR decrease
- P = 0.0210
- Higher NYHA class at the corresponding visit with eGFR decrease
HIC vs usual care treatment effect by baseline eGFR
- Treatment effect of HIC vs usual care independent of baseline eGFR
- P for interaction = 0.4809
- Usual care n = 536
Original publication
Early Changes in Renal Function During Rapid Up-Titration of Guideline-Directed Medical Therapy Following an Admission for Acute Heart Failure. Eur J Heart Fail. Published 20 November 2023. doi:10.1002/ejhf.3074
Summarised from the published abstract; every number is checked against it