TY - JOUR
T1 - Impact of Rapid Up-Titration of Guideline-Directed Medical Therapies on Quality of Life
T2 - Insights from the STRONG-HF Trial
AU - Čelutkiene, Jelena
AU - Čerlinskaite-Bajore, Kamile
AU - Cotter, Gad
AU - Edwards, Christopher
AU - Adamo, Marianna
AU - Arrigo, Mattia
AU - Barros, Marianela
AU - Biegus, Jan
AU - Chioncel, Ovidiu
AU - Cohen-Solal, Alain
AU - Damasceno, Albertino
AU - Diaz, Rafael
AU - Filippatos, Gerasimos
AU - Gayat, Etienne
AU - Kimmoun, Antoine
AU - Léopold, Valentine
AU - Metra, Marco
AU - Novosadova, Maria
AU - Pagnesi, Matteo
AU - Pang, Peter S.
AU - Ponikowski, Piotr
AU - Saidu, Hadiza
AU - Sliwa, Karen
AU - Takagi, Koji
AU - Ter Maaten, Jozine M.
AU - Tomasoni, Daniela
AU - Lam, Carolyn S.P.
AU - Voors, Adriaan A.
AU - Mebazaa, Alexandre
AU - Davison, Beth
N1 - Publisher Copyright:
© 2024 American Heart Association, Inc.
PY - 2024/4
Y1 - 2024/4
N2 - BACKGROUND: This analysis provides details on baseline and changes in quality of life (QoL) and its components as measured by EQ-5D-5L questionnaire, as well as association with objective outcomes, applying high-intensity heart failure (HF) care in patients with acute HF. METHODS: In STRONG-HF trial (Safety, Tolerability, and Efficacy of Rapid Optimization, Helped by NT-proBNP Testing, of Heart Failure Therapies) patients with acute HF were randomized just before discharge to either usual care or a high-intensity care strategy of guideline-directed medical therapy up-titration. Patients ranked their state of health on the EQ-5D visual analog scale score ranging from 0 (the worst imaginable health) to 100 (the best imaginable health) at baseline and at 90 days follow-up. RESULTS: In 1072 patients with acute HF with available assessment of QoL (539/533 patients assigned high-intensity care/usual care) the mean baseline EQ-visual analog scale score was 59.2 (SD, 15.1) with no difference between the treatment groups. Patients with lower baseline EQ-visual analog scale (meaning worse QoL) were more likely to be women, self-reported Black and non-European (P<0.001). The strongest independent predictors of a greater improvement in QoL were younger age (P<0.001), no HF hospitalization in the previous year (P<0.001), lower NYHA class before hospital admission (P<0.001) and high-intensity care treatment (mean difference, 4.2 [95% CI, 2.5-5.8]; P<0.001). No statistically significant heterogeneity in the benefits of high-intensity care was seen across patient subgroups of different ages, with left ventricular ejection fraction above or below 40%, NT-proBNP (N-terminal pro-B-type natriuretic peptide) and systolic blood pressure above or below the median value. The treatment effect on the primary end point did not vary significantly across baseline EQ-visual analog scale (Pinteraction=0.87). CONCLUSIONS: Early up-titration of guideline-directed medical therapy significantly improves all dimensions of QoL in patients with HF and improves prognosis regardless of baseline self-assessed health status. The likelihood of achieving optimal doses of HF medications does not depend on baseline QoL.
AB - BACKGROUND: This analysis provides details on baseline and changes in quality of life (QoL) and its components as measured by EQ-5D-5L questionnaire, as well as association with objective outcomes, applying high-intensity heart failure (HF) care in patients with acute HF. METHODS: In STRONG-HF trial (Safety, Tolerability, and Efficacy of Rapid Optimization, Helped by NT-proBNP Testing, of Heart Failure Therapies) patients with acute HF were randomized just before discharge to either usual care or a high-intensity care strategy of guideline-directed medical therapy up-titration. Patients ranked their state of health on the EQ-5D visual analog scale score ranging from 0 (the worst imaginable health) to 100 (the best imaginable health) at baseline and at 90 days follow-up. RESULTS: In 1072 patients with acute HF with available assessment of QoL (539/533 patients assigned high-intensity care/usual care) the mean baseline EQ-visual analog scale score was 59.2 (SD, 15.1) with no difference between the treatment groups. Patients with lower baseline EQ-visual analog scale (meaning worse QoL) were more likely to be women, self-reported Black and non-European (P<0.001). The strongest independent predictors of a greater improvement in QoL were younger age (P<0.001), no HF hospitalization in the previous year (P<0.001), lower NYHA class before hospital admission (P<0.001) and high-intensity care treatment (mean difference, 4.2 [95% CI, 2.5-5.8]; P<0.001). No statistically significant heterogeneity in the benefits of high-intensity care was seen across patient subgroups of different ages, with left ventricular ejection fraction above or below 40%, NT-proBNP (N-terminal pro-B-type natriuretic peptide) and systolic blood pressure above or below the median value. The treatment effect on the primary end point did not vary significantly across baseline EQ-visual analog scale (Pinteraction=0.87). CONCLUSIONS: Early up-titration of guideline-directed medical therapy significantly improves all dimensions of QoL in patients with HF and improves prognosis regardless of baseline self-assessed health status. The likelihood of achieving optimal doses of HF medications does not depend on baseline QoL.
KW - atrial fibrillation
KW - blood pressure
KW - depression
KW - heart failure
KW - quality of life
UR - https://www.scopus.com/pages/publications/85190375997
U2 - 10.1161/CIRCHEARTFAILURE.123.011221
DO - 10.1161/CIRCHEARTFAILURE.123.011221
M3 - Article
C2 - 38445950
AN - SCOPUS:85190375997
SN - 1941-3289
VL - 17
SP - E011221
JO - Circulation: Heart Failure
JF - Circulation: Heart Failure
IS - 4
ER -