{"id":"42271dbade4e","type":"article","url":"https://hartvaat.nl/2024/07/23/snelle-optitratie-van-neurohormonale-blokkade-en-duurzame-decongestie-bij-hf/","title":"Snelle optitratie van neurohormonale blokkade en duurzame decongestie bij HF","title_en":"Effects of Rapid Uptitration of Neurohormonal Blockade on Effective, Sustainable Decongestion and Outcomes in STRONG-HF.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","bloeddrukbehandeling","carvedilol","nt-probnp"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2024.04.055","source_url":"https://doi.org/10.1016/j.jacc.2024.04.055","authors":["Jan Biegus","Alexandre Mebazaa","Beth Davison","Gad Cotter","Christopher Edwards","Jelena Čelutkienė","Ovidiu Chioncel","Alain Cohen-Solal","Gerasimos Filippatos","Maria Novosadova","Karen Sliwa","Marianna Adamo","Mattia Arrigo","Carolyn S P Lam","Jozine M Ter Maaten","Benjamin Deniau","Marianela Barros","Kamilė Čerlinskaitė-Bajorė","Albertino Damasceno","Rafael Diaz","Etienne Gayat","Antoine Kimmoun","Peter S Pang","Matteo Pagnesi","Hadiza Saidu","Koji Takagi","Daniela Tomasoni","Adriaan A Voors","Marco Metra","Piotr Ponikowski"],"significance":6,"published":"2024-07-23","source_date":"2024-07-23","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This study showed that rapid up-titration of neurohormonal blockade during heart failure hospitalization durably improves decongestion and reduces residual congestion, supporting the STRONG-HF approach of aggressive inpatient optimization.","created":"2026-07-03T10:31:04Z","updated":"2026-07-03T13:30:06Z","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":"Studie onderzocht of snelle optitratie van hartfalenmedicatie de decongestie duurzaam verbetert. De strategie verminderde residuele congestie en heropnames, consistent met STRONG-HF-principes.","abstract_original":"BACKGROUND: Comprehensive uptitration of neurohormonal blockade targets fundamental mechanisms underlying development of congestion and may be an additional approach for decongestion after acute heart failure (AHF). OBJECTIVES: This hypothesis was tested in the STRONG-HF (Safety, Tolerability, and Efficacy of Rapid Optimization, Helped by N-Terminal Pro-Brain Natriuretic Peptide Testing of Heart Failure Therapies) trial. METHODS: In STRONG-HF, patients with AHF were randomized to the high-intensity care (HIC) arm with fast up-titration of neurohormonal blockade or to usual care (UC). Successful decongestion was defined as an absence of peripheral edema, pulmonary rales, and jugular venous pressure <6 cm. RESULTS: At baseline, the same proportion of patients in both arms had successful decongestion (HIC 48% vs UC 46%; P = 0.52). At day 90, higher proportion of patients in the HIC arm (75%) experienced successful decongestion vs the UC arm (68%) (P = 0.0001). Each separate component of the congestion score was significantly better in the HIC arm (all, P < 0.05). Additional markers of decongestion also favored the HIC: weight reduction (adjusted mean difference: -1.36 kg; 95% CI: -1.92 to -0.79 kg), N-terminal pro-B-type natriuretic peptide level, and lower orthopnea severity (all, P < 0.001). More effective decongestion was achieved despite a lower mean daily dose of loop diuretics at day 90 in the HIC arm. Among patients with successful decongestion at baseline, those in the HIC arm had a significantly better chance of sustaining decongestion at day 90. Successful decongestion in all subjects was associated with a lower risk of 180-day HF readmission or all-cause death (HR: 0.40; 95% CI: 0.27-0.59; P < 0.0001). CONCLUSIONS: In STRONG-HF, intensive uptitration of neurohormonal blockade was associated with more efficient and sustained decongestion at day 90 and a lower risk of the primary endpoint."}