{"id":"5dda5dec10ea","type":"article","url":"https://hartvaat.nl/2023/06/06/strong-hf-optitratie-effectief-over-het-hele-ef-spectrum-na-hf-opname/","title":"STRONG-HF: optitratie effectief over het hele EF-spectrum na HF-opname","title_en":"Uptitrating Treatment After Heart Failure Hospitalization Across the Spectrum of Left Ventricular Ejection Fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["hfmref"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2023.03.426","source_url":"https://doi.org/10.1016/j.jacc.2023.03.426","authors":["Matteo Pagnesi","Marco Metra","Alain Cohen-Solal","Christopher Edwards","Marianna Adamo","Daniela Tomasoni","Carolyn S P Lam","Ovidiu Chioncel","Rafael Diaz","Gerasimos Filippatos","Piotr Ponikowski","Karen Sliwa","Adriaan A Voors","Antoine Kimmoun","Maria Novosadova","Koji Takagi","Marianela Barros","Albertino Damasceno","Hadiza Saidu","Etienne Gayat","Peter S Pang","Jelena Celutkiene","Gad Cotter","Alexandre Mebazaa","Beth Davison"],"significance":8,"published":"2023-06-06","source_date":"2023-06-06","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfpef-hartfalen-met-behouden-ejectie/","https://hartvaat.nl/kennis/hartfalen/hfmref-hartfalen-met-matig-verminderde-ejectie/"],"congress":"","summary_en":"This STRONG-HF subanalysis showed that rapid up-titration of guideline-directed therapy after heart failure hospitalization was effective across the entire ejection fraction spectrum, including patients with HFpEF. The results expanded the aggressive post-discharge optimization approach beyond HFrEF.","created":"2026-07-03T10:30:25Z","updated":"2026-07-03T13:29:29Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Subanalyse van STRONG-HF toonde dat snelle optitratie van hartfalenmedicatie na opname effectief was over het hele EF-spectrum, inclusief HFpEF. Dit verbreedt de aanbeveling voor intensieve optitratie naar alle hartfalenfenotypen.","abstract_original":"BACKGROUND: Acute heart failure (AHF) is associated with a poor prognosis regardless of left ventricular ejection fraction (LVEF). STRONG-HF showed the efficacy and safety of a strategy of rapid uptitration of oral treatment for heart failure (HF) and close follow-up (high-intensity care), compared with usual care, in patients recently hospitalized for AHF and enrolled independently from their LVEF. OBJECTIVES: In this study, we sought to assess the impact of baseline LVEF on the effects of high-intensity care vs usual care in STRONG-HF. METHODS: The STRONG-HF trial enrolled patients hospitalized for AHF with any LVEF and not treated with full doses of renin-angiotensin inhibitors, beta-blockers, and mineralocorticoid receptor antagonists. High-intensity care with uptitration of oral medications was performed independently from LVEF. The primary endpoint was the composite of HF rehospitalization or all-cause death at day 180. RESULTS: Among the 1,078 patients randomized, 731 (68%) had LVEF ≤40% and 347 (32%) had LVEF >40%. The treatment benefit of high-intensity care vs usual care on the primary endpoint was consistent across the whole LVEF spectrum (interaction P with LVEF as a continuous variable = 0.372). Mean difference in the EQ-5D visual analog scale change from baseline to day 90 between treatment arms was slightly greater at higher LVEF values, but with no interaction between LVEF as a continuous variable and the treatment strategy (interaction P = 0.358). Serious adverse events were also independent from LVEF. CONCLUSIONS: Rapid uptitration of oral medications for HF and close follow-up reduce 180-day death and HF rehospitalization after AHF hospitalization independently from LVEF. (Safety, Tolerability and Efficacy of Rapid Optimization, Helped by NT-ProBNP Testing, of Heart Failure Therapies [STRONG-HF]; NCT03412201)."}