{"id":"f8636a54c77f","type":"article","url":"https://hartvaat.nl/2025/06/01/strong-hf-socio-economische-status-beinvloedt-gdmt-effect-niet/","title":"STRONG-HF: socio-economische status beïnvloedt GDMT-effect niet","title_en":"Socio-economic status and the effect of guideline-directed medical therapy in the STRONG-HF study.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.15156","source_url":"https://doi.org/10.1002/ehf2.15156","authors":["Albertino Damasceno","Hadiza Saidu","Gad Cotter","Beth Davison","Christopher Edwards","Jelena Celutkiene","Marianna Adamo","Mattia Arrigo","Marianela Barros","Jan Biegus","Kamilė Čerlinskaitė-Bajorė","Ovidiu Chioncel","Alain Cohen-Solal","Benjamin Deniau","Rafael Diaz","Gerasimos Filippatos","Etienne Gayat","Antoine Kimmoun","Carolyn S P Lam","Marco Metra","Maria Novosadova","Matteo Pagnesi","Peter S Pang","Piotr Ponikowski","Jozine M Ter Maaten","Daniela Tomasoni","Adriaan A Voors","Koji Takagi","Alexandre Mebazaa","Karen Sliwa"],"significance":6,"published":"2025-06-01","source_date":"2025-06-01","image":"","kennis":[],"congress":"","summary_en":"This STRONG-HF analysis showed that the benefit of intensive guideline-directed medical therapy up-titration after acute HF is independent of socioeconomic status, supporting equitable implementation across income levels.","created":"2026-07-03T10:31:39Z","updated":"2026-07-03T13:30:39Z","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":"STRONG-HF analyse toonde dat het voordeel van intensieve GDMT-optitratie na acuut HF onafhankelijk is van socio-economische status. De interventie is even effectief bij alle socio-economische groepen.","abstract_original":"AIMS: Acute heart failure (AHF) impacts millions globally, with outcomes varying based on socio-economic status (SES). METHODS: SES measured by annual household income, years of education and medical insurance coverage. Each patient's income and education level relative to the median or mean, respectively, in the country was calculated, and categorized into tertiles (0, 1 or 2 from lowest to highest). SES scores (0-5) were computed as the sum of these levels plus insurance coverage (0 = no or 1 = yes). Patients' baseline characteristics, outcomes (HF readmission, death and their composite) and the effect of high-intensity care (HIC) vs. usual care (UC) were examined by SES scores 0-2, 3 and 4-5. RESULTS: Lower SES patients, who were younger, predominantly female, Black and non-European, had fewer comorbidities such as atrial fibrillation, diabetes and ischaemic heart disease and exhibited milder HF, indicated by a lower NYHA class, lower creatinine and higher cholesterol before discharge. Despite having milder HF and less comorbidities, after adjusting for baseline characteristics, patients with higher SES had numerically better outcomes, though differences were not statistically significant. 180-day hazard ratios (HRs) for HF readmission or death were 0.75 (95% CI 0.48-1.16) for SES scores of 3 and 0.85 (95% CI 0.58-1.23) for scores of 4-5, compared to 0-2. Higher SES patients had numerically better treatment effect from HIC, with HRs of 0.69 for SES 0-2, 0.72 for SES 3 and 0.50 for SES 4-5. CONCLUSIONS: In this post hoc analysis of the STRONG-HF study, lower SES was associated with milder acute HF but similar 180-day outcomes. Higher SES patients benefitted more from HIC."}