Heart failure & cardiomyopathiesSecondary analysis
Optimization of Evidence-Based Heart Failure Medications After an Acute Heart Failure Admission
- Secondary analysis of the STRONG-HF randomised trial
- post hoc
- time-dependent Cox regression
Authors' conclusion
Results of this post hoc analysis of the STRONG-HF randomized clinical trial show that, among patients randomly assigned to high-intensity care, achieving higher doses of HF GDMT 2 weeks after discharge was feasible and safe in most patients.
Study context
- Population
- Patients with acute HF not on optimal guideline-directed medical therapy (GDMT) doses, assigned high-intensity care in STRONG-HFhigh-intensity care
- Participants
- 515 patients
- Comparison
- Achieved GDMT dose categories within high-intensity care
- Lown = 39reference
- Mediumn = 254
- Highn = 222
- Primary endpoint
- HF readmission or all-cause death
- Follow-up
- 180 days after discharge
Primary result
As reported in the abstract
180-day HF readmission or all-cause death, per 10% increase in average percentage optimal dose · 180 days
Adjusted hazard ratio
0.89
95% CI 0.81–0.98
P = 0.01
+10% average optimal dose
aHR 0.89 (95% CI 0.81–0.98); P = 0.01
Per 10% increase in average percentage optimal, as printed
Further findings
| Outcome | aHR (95% CI) | P value | |
|---|---|---|---|
| 180-day all-cause mortality, per 10% increase in dose | 0.84 (0.73–0.95) | P = 0.007 | |
| 0.512Adjusted hazard ratio (log scale) |
| Outcome | mean difference (points) (95% CI) | P value | |
|---|---|---|---|
| Change in quality of life (EQ-5D visual analog scale) · 90 days — Medium vs Low | 0.10 (−4.88 to 5.07) | P = 0.07 | |
| Change in quality of life (EQ-5D visual analog scale) · 90 days — High vs Low | 3.13 (−1.98 to 8.24) | P = 0.07 | |
| −50510Difference, points (linear scale) |
Predictors of uptitration · week 2
- Lower BP and more congestion less likely to be uptitrated to optimal GDMT doses
Safety
Adverse events · to day 90
- Less frequent with higher GDMT doses at week 2
Original publication
Optimization of Evidence-Based Heart Failure Medications After an Acute Heart Failure Admission. JAMA Cardiol. Published 1 February 2024. doi:10.1001/jamacardio.2023.4553
Summarised from the published abstract; every number is checked against it