Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure in elderly patients: A sub-analysis of the STRONG-HF randomized clinical trial

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

*Corresponding author voor dit werk

OnderzoeksoutputAcademicpeer review

14 Citaten (Scopus)
55 Downloads (Pure)

Samenvatting

Aims: STRONG-HF examined a high-intensity care (HIC) strategy of rapid up-titration of guideline-directed medical therapy (GDMT) and close follow-up after acute heart failure (AHF) admission. We assess the role of age on efficacy and safety of HIC. 

Methods and results: Hospitalized AHF patients, not treated with optimal GDMT were randomized to HIC or usual care. The primary endpoint of 180-day death or HF readmission occurred equally in older (>65 years, n = 493, 74 ± 5 years) and younger patients (53 ± 11 years, adjusted hazard ratio [aHR] 1.02, 95% confidence interval [CI] 0.73–1.43, p = 0.89). Older patients received slightly lower GDMT to day 21, but same doses at day 90 and 180. The effect of HIC on the primary endpoint was numerically higher in younger (aHR 0.51, 95% CI 0.32–0.82) than older patients (aHR 0.73, 95% CI 0.46–1.15, adjusted interaction p = 0.30), partially related to COVID-19 deaths. After exclusion of COVID-19 deaths, the effect of HIC was similar in younger (aHR 0.51, 95% CI 0.32–0.82) and older patients (aHR 0.63, 95% CI 0.32–1.02, adjusted interaction p = 0.56), with no treatment-by-age interaction (interaction p = 0.57). HIC induced larger improvements in quality of life to day 90 in younger (EQ-VAS adjusted-mean difference 5.51, 95% CI 3.20–7.82) than in older patients (1.77, 95% CI −0.75 to 4.29, interaction p = 0.032). HIC was associated with similar rates of adverse events in older and younger patients. 

Conclusion: High-intensity care after AHF was safe and resulted in a significant reduction of all-cause death or HF readmission at 180 days across the study age spectrum. Older patients have smaller benefits in terms of quality of life.

Originele taal-2English
Pagina's (van-tot)1145-1155
Aantal pagina's11
TijdschriftEuropean Journal of Heart Failure
Volume25
Nummer van het tijdschrift7
DOI's
StatusPublished - jul.-2023

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