NT-proBNP and high intensity care for acute heart failure: the STRONG-HF trial

Marianna Adamo, Matteo Pagnesi, Alexandre Mebazaa, Beth Davison, Christopher Edwards, Daniela Tomasoni, Mattia Arrigo, Marianela Barros, Jan Biegus, Jelena Celutkiene, Kamilė Čerlinskaitė-Bajorė, Ovidiu Chioncel, Alain Cohen-Solal, Albertino Damasceno, Rafael Diaz, Gerasimos Filippatos, Etienne Gayat, Antoine Kimmoun, Carolyn S.P. Lam, Maria NovosadovaPeter S. Pang, Piotr Ponikowski, Hadiza Saidu, Karen Sliwa, Koji Takagi, Jozine M. Ter Maaten, Adriaan Voors, Gad Cotter, Marco Metra*

*Corresponding author voor dit werk

OnderzoeksoutputAcademicpeer review

25 Citaten (Scopus)
56 Downloads (Pure)

Samenvatting

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.

Originele taal-2English
Pagina's (van-tot)2947-2962
Aantal pagina's16
TijdschriftEuropean Heart Journal
Volume44
Nummer van het tijdschrift31
DOI's
StatusPublished - 14-aug.-2023

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