Impact of Rapid Up-Titration of Guideline-Directed Medical Therapies on Quality of Life: Insights from the STRONG-HF Trial

Jelena Čelutkiene*, Kamile Čerlinskaite-Bajore, Gad Cotter, Christopher Edwards, Marianna Adamo, Mattia Arrigo, Marianela Barros, Jan Biegus, Ovidiu Chioncel, Alain Cohen-Solal, Albertino Damasceno, Rafael Diaz, Gerasimos Filippatos, Etienne Gayat, Antoine Kimmoun, Valentine Léopold, Marco Metra, Maria Novosadova, Matteo Pagnesi, Peter S. PangPiotr Ponikowski, Hadiza Saidu, Karen Sliwa, Koji Takagi, Jozine M. Ter Maaten, Daniela Tomasoni, Carolyn S.P. Lam, Adriaan A. Voors, Alexandre Mebazaa, Beth Davison

*Corresponding author voor dit werk

OnderzoeksoutputAcademicpeer review

7 Citaten (Scopus)
8 Downloads (Pure)

Samenvatting

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.

Originele taal-2English
Pagina's (van-tot)E011221
Aantal pagina's12
TijdschriftCirculation: Heart Failure
Volume17
Nummer van het tijdschrift4
DOI's
StatusPublished - apr.-2024

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