Cardio ThinkLab
 

STRONG-HF study highlighting benefits of treatment optimisation

25 April 2023

 

Four doctors wearing white coats standing around a large model of a human heart. Speech bubbles from the doctors include illustrations of a checklist, DNA, pills and an ECG.
Text reading:" Strong-HF contemporary post-discharge management in heart-failure."

Primary outcomes

Heart failure patients currently have high rates of readmission and mortality after discharge1-4

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The burden of heart failure

64.3 million adults suffer from heart failure1
Outline of 4 people, 3 in light brown colour and 1 in red.

1 in 4 patients are re-admitted within 30 days of discharge1,2,3

Outlines of 4 people, 2 in light brown colour and 2 in red.

About 1 in 2 patients are re-admitted within 6 months4

Outline of 4 people, 2 in light brown colour and 2 in red.

More than 1 in 2 patients die within 5 years with survival rates worse than:

  • colon cancer
  • breast cancer
  • prostate cancer1

What are the challenges of post-discharge management?

Majority of heart failure patients are not closely monitored or treated with optimal doses of GDMT5-11 after acute heart failure admission.

Person putting one hand to their chest next to a magnifying glass with a heart symbol inside it. A pill bottle with a downward arrow next to it.

ACEis, ARBs, MRAs and beta-blockers showed to improve survival rates.12

A pill bottle with an upward pointing arrow next to it. The text: ACEi, ARB, ARNi, MRA, SGLT21 and BB is written in a circle around the bottle.

Factors influencing limited adherence to GDMT (Guideline Directed Medical Therapy).13

Physician:
  1. Lack of awareness
  2. Focus on treating symptoms
  3. Fear of adverse effects
Patient:
  1. Age
  2. Frailty and sensitivity
  3. Intolerance and contraindications
Non-medical:
  1. High costs
  2. Limited access

STRONG-HF primary outcomes show significant reduction of all cause death or acute heart failure readmissions

Study Design

1,078 patients enrolled out of planned 1800, age 18-85 years old from 87 hospitals in 14 countries
1,078
patients enrolled
out of planned 1800†
18-85
years old
87
hospital
14
countries

†Monitoring board of the study recommended to terminate the study early as it was considered unethical to continue with usual care.

Randomized study of 1078 HF patients with main inclusion criteria of: Patient with AHF ready to be discharged, no or sub-optimal dose of GDMT and pre-discharge NT-proBNP of >1500pg/mL. Half of the sample patients undergo high intensity care, half undergo usual care. Under high intensity care, patients are given controlled GDMT of half optimal dose 1 week before and after discharge, and full optimal GDMT dose from week 2 to week 6 post-discharge. The other half undergoes usual care of follow-ups and therapy adjustments per physician’s usual practice. Both groups undergo a 90-day follow up. At the endpoint of the study at 180 days after discharge, the number of HF patients readmitted or all-cause mortality is recorded.

*ACEi/ARB, ARNi, BB, or MRA; **NT-proBNP criteria for persistent congestion ACEi, angiotensin-converting enzyme inhibitors; AHF, acute heart failure; ARB, angiotensin receptor blockers; BB, beta blockers; GDMT, guideline-directed medical therapy; HF, heart failure; MRA, mineralocorticoid receptor antagonists; NT-proBNP, N-terminal pro b-type natriuretic peptide

Measuring NT-proBNP biomarker levels is an integral part of the treatment strategy in STRONG-HF.

Results

The high intensity care group: 34% relative and 8.1% absolute risk reduction (ARR) in the combination of death or heart failure readmission.14

A bar graph showing a downward trend.
CV (cardiovascular) death
26% lower
HF readmission
44% lower
All-cause death
16% lower
STRONG-HF study results demonstrated clear benefits for acute heart failure patients by adapting the strategy of care.

References:
1 Ponikowski P, et al. ESC Heart Fail. 2014;1(1):4-25.
2 Krumholz HM, et al. Circ Cardiovasc Qual Outcomes. 2009;2:407-413.
3 Cowie MR, et al. Improving care for patients are acute heart failure [Internet; cited 2013]. Available from: http://www.oxfordhealthpolicyforum.org/reports/acute-heart-failure/improving-care-for-patients-with-acute-heart-failure.
4 Butler J, et al. Congest Heart Fail. 2012;18(5 Suppl 1):S1-S3.
5 Chioncel O, et al. Eur J Heart Fail. 2017;19:1242-1254;
6 Granger BB, et al., J Card Fail. 2022;28:1355-1361.
7 Butler J, et al. Eur J Heart Fail. 2021;23:1334-1342.
8 Greene SJ, et al., J Am Coll Cardiol. 2018;72:351-366.
9 Joseph S, et al. Eur Heart J. 2021;43:908-915.
10 Damasceno A, et al., Arch Intern Med. 2012;172:1386-1394.
11 Čerlinskaitė K, et al. ESC Heart Fail. 2021;8:2473-2484.
12 McDonagh TA, et al. Eur Heart J. 2021 Sep 21;42(36):3599-3726.
13 Komajda M, et al. Eur J Heart Fail. 2016;18(5):514-22.
14 Mebazaa A, et al. The Lancet. 2022; S0140-6736(22)02076-1.

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