Push heart failure meds to the max

3 minute read

Intensive drug treatment after hospitalisation for heart failure significantly cuts the risk of readmission and death.

Intensive treatment with heart failure medication following hospitalisation significantly reduces the risk of dying or readmission.

The study was stopped early because the benefits of intensive treatment were much higher than expected.

The multinational, randomised trial involving more than 1000 acute heart failure patients found those who received intensive were 34% less likely to have died or be readmitted after six months than those patients whose treatment was more slowly up-titrated.

Treatment in both groups included three classes of heart failure medication: beta-blockers, renin-angiotensin inhibitors/angiotensin receptor-neprilysin inhibitors (ARNIs), and mineralocorticoid receptor antagonists.

Participants in the high-intensity group were given 50% of the maximum recommended doses of the three medications immediately post-event, and this rose to 100% of the recommended dosage within two weeks.

Patients in the usual-care group had their medication dosage increased at a slower pace. After three months, only a small minority of patients in this group received 100% of the recommended doses.

In the following six months, 15% of patients in the high-intensity care group were readmitted for heart failure or died, compared to 23% of patients in the usual care group

The research also shows that up-titrating three heart failure medications to the maximum dosage early on is safe during the vulnerable early discharge period, the authors wrote in The Lancet.

“The STRONG-HF study shows that most patients admitted for acute heart failure and not treated with optimal doses of oral heart failure therapies can be rapidly and safely up-titrated to recommended doses of drugs within a few weeks after discharge,” the authors wrote.

“This high-intensity strategy was safe and associated with a reduced risk of death or being readmitted for heart failure at 180 days after an acute heart failure episode.”

Researchers conceded that the high intensity treatment was associated with more side effects (41% vs 29% after 90 days).

However, most of these side effects were minor and the risk of serious adverse events was similar across the two groups (16% ivs 17% in the usual care group), as were the risk of fatal adverse events (5% vs 6%).

“This increase in adverse events did not translate into an increase in serious adverse events nor fatal adverse events,” the authors wrote.

Of note, the study was conducted prior to SGLT-2 inhibitors being approved for heart failure, and consequently only a few participants received this treatment late in the trial. Intravenous iron supplementation was also not yet recommended when the trail began, they said.

The study was presented at the American Heart Association’s Scientific Sessions 2022 in Chicago in November.

The Lancet 2022, online 7 November

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