TY - JOUR
T1 - NT-proBNP and high intensity care for acute heart failure
T2 - the STRONG-HF trial
AU - Adamo, Marianna
AU - Pagnesi, Matteo
AU - Mebazaa, Alexandre
AU - Davison, Beth
AU - Edwards, Christopher
AU - Tomasoni, Daniela
AU - Arrigo, Mattia
AU - Barros, Marianela
AU - Biegus, Jan
AU - Celutkiene, Jelena
AU - Čerlinskaitė-Bajorė, Kamilė
AU - Chioncel, Ovidiu
AU - Cohen-Solal, Alain
AU - Damasceno, Albertino
AU - Diaz, Rafael
AU - Filippatos, Gerasimos
AU - Gayat, Etienne
AU - Kimmoun, Antoine
AU - Lam, Carolyn S.P.
AU - Novosadova, Maria
AU - Pang, Peter S.
AU - Ponikowski, Piotr
AU - Saidu, Hadiza
AU - Sliwa, Karen
AU - Takagi, Koji
AU - Ter Maaten, Jozine M.
AU - Voors, Adriaan
AU - Cotter, Gad
AU - Metra, Marco
N1 - Publisher Copyright:
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved.
PY - 2023/8/14
Y1 - 2023/8/14
N2 - Aims: STRONG-HF showed that rapid up-titration of guideline-recommended medical therapy (GRMT), in a high intensity care (HIC) strategy, was associated with better outcomes compared with usual care. The aim of this study was to assess the role of N-terminal pro-B-type natriuretic peptide (NT-proBNP) at baseline and its changes early during up-titration.Methods: A total of 1077 patients hospitalized for acute heart failure (HF) and with a >10% NT-proBNP decrease from screening (i.e. and results admission) to randomization (i.e. pre-discharge), were included. Patients in HIC were stratified by further NT-proBNP changes, from randomization to 1 week later, as decreased (≥30%), stable (<30% decrease to ≤10% increase), or increased (>10%). The primary endpoint was 180-day HF readmission or death. The effect of HIC vs. usual care was independent of baseline NT-proBNP. Patients in the HIC group with stable or increased NT-proBNP were older, with more severe acute HF and worse renal and liver function. Per protocol, patients with increased NT-proBNP received more diuretics and were up-titrated more slowly during the first weeks after discharge. However, by 6 months, they reached 70.4% optimal GRMT doses, compared with 80.3% for those with NT-proBNP decrease. As a result, the primary endpoint at 60 and 90 days occurred in 8.3% and 11.1% of patients with increased NT-proBNP vs. 2.2% and 4.0% in those with decreased NT-proBNP (P = 0.039 and P = 0.045, respectively). However, no difference in outcome was found at 180 days (13.5% vs. 13.2%; P = 0.93).Conclusion: Among patients with acute HF enrolled in STRONG-HF, HIC reduced 180-day HF readmission or death regardless of baseline NT-proBNP. GRMT up-titration early post-discharge, utilizing increased NT-proBNP as guidance to increase diuretic therapy and reduce the GRMT up-titration rate, resulted in the same 180-day outcomes regardless of early post-discharge NT-proBNP change.
AB - Aims: STRONG-HF showed that rapid up-titration of guideline-recommended medical therapy (GRMT), in a high intensity care (HIC) strategy, was associated with better outcomes compared with usual care. The aim of this study was to assess the role of N-terminal pro-B-type natriuretic peptide (NT-proBNP) at baseline and its changes early during up-titration.Methods: A total of 1077 patients hospitalized for acute heart failure (HF) and with a >10% NT-proBNP decrease from screening (i.e. and results admission) to randomization (i.e. pre-discharge), were included. Patients in HIC were stratified by further NT-proBNP changes, from randomization to 1 week later, as decreased (≥30%), stable (<30% decrease to ≤10% increase), or increased (>10%). The primary endpoint was 180-day HF readmission or death. The effect of HIC vs. usual care was independent of baseline NT-proBNP. Patients in the HIC group with stable or increased NT-proBNP were older, with more severe acute HF and worse renal and liver function. Per protocol, patients with increased NT-proBNP received more diuretics and were up-titrated more slowly during the first weeks after discharge. However, by 6 months, they reached 70.4% optimal GRMT doses, compared with 80.3% for those with NT-proBNP decrease. As a result, the primary endpoint at 60 and 90 days occurred in 8.3% and 11.1% of patients with increased NT-proBNP vs. 2.2% and 4.0% in those with decreased NT-proBNP (P = 0.039 and P = 0.045, respectively). However, no difference in outcome was found at 180 days (13.5% vs. 13.2%; P = 0.93).Conclusion: Among patients with acute HF enrolled in STRONG-HF, HIC reduced 180-day HF readmission or death regardless of baseline NT-proBNP. GRMT up-titration early post-discharge, utilizing increased NT-proBNP as guidance to increase diuretic therapy and reduce the GRMT up-titration rate, resulted in the same 180-day outcomes regardless of early post-discharge NT-proBNP change.
KW - Biomarkers
KW - Heart failure
KW - Medical therapy
UR - https://www.scopus.com/pages/publications/85168821820
U2 - 10.1093/eurheartj/ehad335
DO - 10.1093/eurheartj/ehad335
M3 - Article
C2 - 37217188
AN - SCOPUS:85168821820
SN - 0195-668X
VL - 44
SP - 2947
EP - 2962
JO - European Heart Journal
JF - European Heart Journal
IS - 31
ER -