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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Early changes in renal function during rapid up-titration of guideline-directed medical therapy following an admission for acute heart failure
European Journal of Heart Failure, Year 2023
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Description
Aim: In this subgroup analysis of STRONG-HF, we explored the association between changes in renal function and efficacy of rapid up-titration of guideline-directed medical therapy (GDMT) according to a high-intensity care (HIC) strategy. Methods and results: In patients randomized to the HIC arm (n = 542), renal function was assessed at baseline and during follow-up visits. We studied the association with clinical characteristics and outcomes of a decrease in estimated glomerular filtration rate (eGFR) at week 1, defined as ≥15% decrease from baseline. Patients in the usual care group (n = 536) were seen at day 90. The treatment effect of HIC versus usual care was independent of baseline eGFR (p-interaction = 0.4809). A decrease in eGFR within 1 week occurred in 77 (15.5%) patients and was associated with more rales on examination (p = 0.004), and a higher New York Heart Association class at the corresponding visit. Following the decrease in eGFR at 1 week, lower average optimal doses of GDMT were prescribed during follow-up (p = 0.0210) and smaller reductions in N-terminal pro-B-type natriuretic peptide occurred (geometrical mean 0.81 in no eGFR decrease vs 1.12 in GFR decrease, p = 0.0003). The rate of heart failure (HF) readmission or death at 180 days was 12.3% in no eGFR decrease versus 18.5% in eGFR decrease (p = 0.2274) and HF readmissions were 7.8% versus 16.6% (p = 0.0496). Conclusions: In the STRONG-HF study, HIC reduced 180-day HF readmission or death regardless of baseline eGFR. An early decrease in eGFR during rapid up-titration of GDMT was associated with more evidence of congestion, yet lower doses of GDMT during follow-up. © 2023 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
Authors & Co-Authors
ter Maaten, Jozine M.
Netherlands, Groningen
Rijksuniversiteit Groningen
Mebazaa, Alexandre
France, Paris
Inserm
France, Paris
Ap-hp Assistance Publique - Hopitaux de Paris
Davison, Beth A.
France, Paris
Inserm
United States, Durham
Momentum Research, Inc
United States, Durham
Heart Initiative
Edwards, Christopher
United States, Durham
Momentum Research, Inc
Adamo, Marianna
Italy, Brescia
Spedali Civili Di Brescia
Arrigo, Mattia
Switzerland, Zurich
Stadtspital Zürich
Barros, Marianela
United States, Durham
Momentum Research, Inc
Biegus, Jan
Poland, Wroclaw
Wroclaw Medical University
Čelutkiene, Jelena
Lithuania, Vilnius
Vilniaus Universitetas
Čerlinskaitė-Bajorė, Kamilė A.M.I.L.
Lithuania, Vilnius
Vilniaus Universitetas
Chioncel, O. D.
Romania, Bucharest
Universitatea de Medicina si Farmacie Carol Davila Din Bucuresti
Cohen-Solal, Alain
France, Paris
Inserm
France, Paris
Ap-hp Assistance Publique - Hopitaux de Paris
Damasceno, A. Antonio Moura
Mozambique, Maputo
Universidade Eduardo Mondlane
Díaz, Rafaël J.
Argentina, Rosario
Estudios Clínicos Latinoamérica, Argentina
Filippatos, Gerasimos S.
Greece, Athens
Attikon University Hospital
Gayat, Étienne
France, Paris
Inserm
France, Paris
Ap-hp Assistance Publique - Hopitaux de Paris
Kimmoun, Antoine
France, Nancy
Chu de Nancy
Lam, Carolyn Su Ping
Netherlands, Groningen
Rijksuniversiteit Groningen
Singapore, Singapore City
National University of Singapore
Léopold, Valentine
France, Paris
Inserm
France, Paris
Ap-hp Assistance Publique - Hopitaux de Paris
Novosadova, Maria
United States, Durham
Heart Initiative
Pagnesi, Matteo
Italy, Brescia
Spedali Civili Di Brescia
Pang, Peter S.
United States, Indianapolis
Indiana University School of Medicine
Ponikowski, Piotr P.
Poland, Wroclaw
Wroclaw Medical University
Sa’idu, Hadiza
Nigeria, Kano
Bayero University
Sliwa, Karen S.
South Africa, Observatory
Groote Schuur Hospital
Takagi, Koji
United States, Durham
Momentum Research, Inc
Tomasoni, Daniela
Italy, Brescia
Spedali Civili Di Brescia
Cotter, Gad
France, Paris
Inserm
United States, Durham
Momentum Research, Inc
United States, Durham
Heart Initiative
Voors, Adriaan Alexander
Netherlands, Groningen
Rijksuniversiteit Groningen
Statistics
Authors: 29
Affiliations: 18
Identifiers
Doi:
10.1002/ejhf.3074
ISSN:
13889842
Study Design
Cohort Study
Quasi Experimental Study