Heart failure & cardiomyopathiesSecondary analysis
Titration of Medications After Acute Heart Failure Is Safe, Tolerated, and Effective Regardless of Risk
- Secondary analysis of the STRONG-HF randomised trial
- subgroup analysis by MAGGIC risk score
Authors' conclusion
HIC led to better use of GDMT and lower HF-related morbidity and mortality compared with UC, regardless of the underlying HF risk profile.
Study context
- Population
- Patients with acute heart failure (HF), stratified by MAGGIC HF risk score1,062 with MAGGIC score
- Participants
- 1,078 patients
- Comparison
- High-intensity care vs usual care
- Primary endpoint
- All-cause death or first HF rehospitalization
- Follow-up
- Day 180
Primary result
As reported in the abstract
All-cause death or HF readmission by MAGGIC risk score
Hazard ratio
0.66
95% CI 0.50–0.86
HIC vs UC
HR 0.66 (95% CI 0.50–0.86)
- Incidence in MAGGIC tertiles 1, 2 and 3
- 16.3%, 18.9%, and 23.2%
- High-intensity care (HIC) vs usual care (UC) across MAGGIC tertiles 1, 2 and 3 (categorical), as printed
- HR: 0.51; 95% CI: 0.62-0.68
- Effect consistent across MAGGIC tertiles and continuous MAGGIC score
- interaction nonsignificant
Further findings
Guideline-directed medical therapy (GDMT) prescriptions achieved by medication class
- Higher with HIC vs UC, no difference by MAGGIC tertile
- interaction nonsignificant
Safety
Adverse events
- Higher rate with HIC, not differing by MAGGIC tertile
- interaction nonsignificant
Original publication
Titration of Medications After Acute Heart Failure Is Safe, Tolerated, and Effective Regardless of Risk. JACC Heart Fail. Published 12 May 2024. doi:10.1016/j.jchf.2024.04.017
Summarised from the published abstract; every number is checked against it