# Snelle optitratie van neurohormonale blokkade en duurzame decongestie bij HF

*geplaatst 2024-07-23 · Hartfalen · Journal of the American College of Cardiology · doi 10.1016/j.jacc.2024.04.055 · https://hartvaat.nl/2024/07/23/snelle-optitratie-van-neurohormonale-blokkade-en-duurzame-decongestie-bij-hf/*

Studie onderzocht of snelle optitratie van hartfalenmedicatie de decongestie duurzaam verbetert. De strategie verminderde residuele congestie en heropnames, consistent met STRONG-HF-principes.

## English: Effects of Rapid Uptitration of Neurohormonal Blockade on Effective, Sustainable Decongestion and Outcomes in STRONG-HF.

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.

## Abstract (original, from the publication)

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.

Auteurs: 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

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Bron: Journal of the American College of Cardiology, https://doi.org/10.1016/j.jacc.2024.04.055. Bijgewerkt 2026-07-03T13:30:06Z. 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.