作者
Marianna Adamo,Matteo Pagnesi,Alexandre Mebazaa,Beth A. Davison,Christopher Edwards,Daniela Tomasoni,Mattia Arrigo,Marianela Barros,Jan Biegus,Jelena Čelutkienė,Kamilė Čerlinskaitė‐Bajorė,Ovidiu Chioncel,Alain Cohen‐Solal,Albertino Damasceno,Rafael Dı́az,Gerasimos Filippatos,Étienne Gayat,Antoine Kimmoun,Carolyn S.P. Lam,Maria Novosadova,Peter S. Pang,Piotr Ponikowski,Hadiza Saidu,Karen Sliwa,Koji Takagi,Jozine M. ter Maaten,Adriaan A. Voors,Gad Cotter,Marco Metra
摘要
STRONG-HF showed that rapid up-titration of guideline-recommended medical therapy (GRMT), in a high intensity care (HIC) strategy, was associated with better outcomes compared with usual care. The aim of this study was to assess the role of N-terminal pro-B-type natriuretic peptide (NT-proBNP) at baseline and its changes early during up-titration.A total of 1077 patients hospitalized for acute heart failure (HF) and with a >10% NT-proBNP decrease from screening (i.e. admission) to randomization (i.e. pre-discharge), were included. Patients in HIC were stratified by further NT-proBNP changes, from randomization to 1 week later, as decreased (≥30%), stable (<30% decrease to ≤10% increase), or increased (>10%). The primary endpoint was 180-day HF readmission or death. The effect of HIC vs. usual care was independent of baseline NT-proBNP. Patients in the HIC group with stable or increased NT-proBNP were older, with more severe acute HF and worse renal and liver function. Per protocol, patients with increased NT-proBNP received more diuretics and were up-titrated more slowly during the first weeks after discharge. However, by 6 months, they reached 70.4% optimal GRMT doses, compared with 80.3% for those with NT-proBNP decrease. As a result, the primary endpoint at 60 and 90 days occurred in 8.3% and 11.1% of patients with increased NT-proBNP vs. 2.2% and 4.0% in those with decreased NT-proBNP (P = 0.039 and P = 0.045, respectively). However, no difference in outcome was found at 180 days (13.5% vs. 13.2%; P = 0.93).Among patients with acute HF enrolled in STRONG-HF, HIC reduced 180-day HF readmission or death regardless of baseline NT-proBNP. GRMT up-titration early post-discharge, utilizing increased NT-proBNP as guidance to increase diuretic therapy and reduce the GRMT up-titration rate, resulted in the same 180-day outcomes regardless of early post-discharge NT-proBNP change.