Heart failure & cardiomyopathiesSecondary analysis
Rapid Uptitration of Guideline-Directed Medical Therapies in Acute Heart Failure With and Without Atrial Fibrillation
- Secondary analysis of the STRONG-HF randomised trial
- subgroup analysis by AF/AFL status and type
Authors' conclusion
Nearly half of acute HF patients have AF/AFL history. Rapid GDMT uptitration before and early after discharge is feasible, is safe, and may improve outcomes regardless of AF presence or type.
Study context
- Population
- Patients hospitalised for acute heart failure (HF), with and without AF/AFL496 (46%) with AF history
- Participants
- 1,078 patients
- Comparison
- High-intensity care vs usual care, by AF/AFL status
- High-intensity care (HIC), AFn = 238
- Usual care (UC), AFn = 258reference
- HIC, no AF/AFLn = 304
- UC, no AF/AFLn = 277reference
- Primary endpoint
- All-cause death or HF readmission
- Follow-up
- Day 180
Primary result
As reported in the abstract
All-cause death or HF readmission, by AF status
Adjusted hazard ratio (95% CI)
HIC, AF vs UC, AFAF
0.75(0.48–1.19)
HIC, no AF/AFL vs UC, no AF/AFLnon-AF/AFL
0.50(0.31–0.79)
Further findings
| Outcome | average absolute difference (%) (95% CI) | |
|---|---|---|
| Average % optimal dose of neurohormonal inhibitors in HIC, AF/AFL vs non-AF/AFL · day 90 · both ≈80% of optimal dose | −0.81 (−3.51 to 1.89) | |
| −4−202Difference, % (linear scale) |
Uptitration and outcomes by AF/AFL type
- AF/AFL type did not affect uptitration or outcomes
Safety
Adverse events
- Adverse event rates similar with and without AF/AFL
Original publication
Rapid Uptitration of Guideline-Directed Medical Therapies in Acute Heart Failure With and Without Atrial Fibrillation. JACC Heart Fail. Published 14 August 2024. doi:10.1016/j.jchf.2024.06.010
Summarised from the published abstract; every number is checked against it