Heart failure & cardiomyopathiesSecondary analysis
Guideline-directed Medical Therapy (GDMT) is Associated with Reduced Loop Diuretic Requirements, Whereas Diuretic Dose Does Not Modify GDMT Benefit in Heart Failure: STRONG-HF.
- post-hoc analysis of STRONG-HF
Authors' conclusion
GDMT optimization acted as diuretic-sparing therapy: reaching target doses, particularly of all three classes, was associated with markedly lower LD requirement. LD dose mirrored HF severity but neither consistently predicted outcome nor modified the benefit of up-titration.
Study context
- Population
- Patients with heart failure in STRONG-HF with post-randomization loop diuretic datawith post-randomization loop diuretics (LD) data
- Participants
- 1,075 patients
- Comparison
- change at day 90 was compared by achievement of 100% target GDMT doses
- Primary endpoint
- all-cause death or HF rehospitalization
- Follow-up
- 180 days
Primary result
As reported in the abstract
- LD dose category was not independently associated with the primary endpoint or its components
Further findings
All-cause mortality with LD dose doubling
| Comparison | adjusted HR (95% CI) | P value | |
|---|---|---|---|
| LD dose doubling | 1.47 (1.04–2.09) | ||
| 0.512Adjusted hazard ratio (log scale) |
mg
| Outcome | Achieving 100% of target doses of all GDMT classes | not reaching targets | Estimate | P value |
|---|---|---|---|---|
| Change in furosemide-equivalent dose · day 90 | −21.94 (SD 52.46) | −1.55 (SD 49.886) | P < 0.001 |
- All-cause mortality with LD dose doubling: without association with the primary endpoint or rehospitalization (both p>0.05)
Change in furosemide-equivalent dose, beta-blockers (largest effect of any single class) · day 90
- beta-blockers
- −18.42 (SD 49.61) mg, (p<0.001)
Heart failure (HF) severity by LD dose
- Higher LD doses marked more severe HF
Benefit of high-intensity care across LD dose groups
- consistent across LD dose groups (no treatment-by-dose interaction)
Original publication
GDMT is Associated with Reduced Loop Diuretic Requirements, Whereas Diuretic Dose Does Not Modify GDMT Benefit in Heart Failure: STRONG-HF. Eur J Heart Fail. Published 9 October 2026. doi:10.1093/ejhf/xuag309
Summarised from the published abstract; every number is checked against it