Eur J Heart Fail. 2023 Oct 31. doi: 10.1002/ejhf.3074. Online ahead of print.
ABSTRACT
INTRODUCTION: 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: 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.
RESULTS: 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 NYHA 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 NT-proBNP occurred (geometrical mean 0.81 in no eGFR decrease vs 1.12 in GFR decrease, P = 0.0003). The rate of HF readmission or death at 180 days was 12.3% in no eGFR decrease vs. 18.5% in eGFR decrease (P = 0.2274) and HF readmissions were 7.8% vs 16.6% respectively, 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 uptitration of GDMT was associated with more evidence of congestion yet lower doses of GDMT during follow-up. This article is protected by copyright. All rights reserved.
PMID:37905361 | DOI:10.1002/ejhf.3074