| Authors |
ter Maaten, Jozine M ; Mebazaa, Alexandre ; Davison, Beth ; Edwards, Christopher ; Adamo, Marianna ; Arrigo, Mattia ; Barros, Marianela ; Biegus, Jan ; Čelutkienė, Jelena ; Čerlinskaitė-Bajorė, Kamilė ; Chioncel, Ovidiu ; Cohen-Solal, Alain ; Damasceno, Albertino ; Diaz, Rafael ; Filippatos, Gerasimos ; Gayat, Etienne ; Kimmoun, Antoine ; Lam, Carolyn S.P ; Leopold, Valentine ; Novosadova, Maria ; Pagnesi, Matteo ; Pang, Peter S ; Ponikowski, Piotr ; Saidu, Hadiza ; Sliwa, Karen ; Takagi, Koji ; Tomasoni, Daniela ; Metra, Marco ; Cotter, Gad ; Voors, Adriaan A |
| Abstract [eng] |
Aim: In this subgroup analysis of STRONG-HF, we explored the association between changes in renal function and efficacy of rapid up-titration of guideline-directed medical therapy (GDMT) according to a high-intensity care (HIC) strategy. Methods and results: In patients randomized to the HIC arm (n = 542), renal function was assessed at baseline and during follow-up visits. We studied the association with clinical characteristics and outcomes of a decrease in estimated glomerular filtration rate (eGFR) at week 1, defined as ≥15% decrease from baseline. Patients in the usual care group (n = 536) were seen at day 90. The treatment effect of HIC versus usual care was independent of baseline eGFR (p-interaction = 0.4809). A decrease in eGFR within 1 week occurred in 77 (15.5%) patients and was associated with more rales on examination (p = 0.004), and a higher New York Heart Association class at the corresponding visit. Following the decrease in eGFR at 1 week, lower average optimal doses of GDMT were prescribed during follow-up (p = 0.0210) and smaller reductions in N-terminal pro-B-type natriuretic peptide occurred (geometrical mean 0.81 in no eGFR decrease vs 1.12 in GFR decrease, p = 0.0003). The rate of heart failure (HF) readmission or death at 180 days was 12.3% in no eGFR decrease versus 18.5% in eGFR decrease (p = 0.2274) and HF readmissions were 7.8% versus 16.6% (p = 0.0496). Conclusions: In the STRONG-HF study, HIC reduced 180-day HF readmission or death regardless of baseline eGFR. An early decrease in eGFR during rapid up-titration of GDMT was associated with more evidence of congestion, yet lower doses of GDMT during follow-up. |
