# STRONG-HF: NT-proBNP-geleide intensieve optitratie na acuut HF

*geplaatst 2023-08-14 · Hartfalen · European heart journal · doi 10.1093/eurheartj/ehad335 · https://hartvaat.nl/2023/08/14/strong-hf-nt-probnp-geleide-intensieve-optitratie-na-acuut-hf/*

Subanalyse van STRONG-HF toonde dat NT-proBNP-geleide intensieve optitratie van hartfalenmedicatie na ontslag de uitkomsten verbeterde. De biomarker identificeert patiënten die het meest baat hebben bij snelle medicatie-ophoging.

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

This STRONG-HF analysis showed that NT-proBNP-guided intensive up-titration of heart failure medications after discharge improves outcomes, demonstrating that biomarker monitoring adds value to the aggressive post-discharge optimization strategy.

## Abstract (original, from the publication)

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 AND RESULTS: A total of 1077 patients hospitalized for acute heart failure (HF) and with a >10% NT-proBNP decrease from screening (i.e. 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.

Auteurs: 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 Novosadova, Peter S Pang, Piotr Ponikowski, Hadiza Saidu, Karen Sliwa, Koji Takagi, Jozine M Ter Maaten, Adriaan Voors, Gad Cotter, Marco Metra

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Bron: European heart journal, https://doi.org/10.1093/eurheartj/ehad335. Bijgewerkt 2026-07-03T13:29:35Z. 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.