PRIMARY OUTCOMES
Heart failure patients currently havehigh rates of readmission andmortality after discharge1-4
The burden of heart failure
1 in 4 patients are re-admitted within
30 days of discharge1,2,3

About 1 in 2 patients are re-admitted
within 6 months4

64.3 million

More than 1 in 2 die within 5 years
with survival rates worse than:• colon cancer• breast cancer• prostate cancer1

adults suffer fromheart failure1

What are the challenges ofpost-discharge management?
Majority of heart failure patients are notclosely monitored or treated withoptimal doses of GDMT5–11 after acuteheart failure admission.

ACEis, ARBs, MRAs and beta-blockers
showed to improve survival rates.12

Factors inﬂuencing limited adherence to GDMT (Guideline Directed Medical Therapy)13

Physician:Patient:

Non-medical:

1. Lack of awareness2. Focus on treating
symptoms
3. Fear of adverse effects

1. Age2. Frailty and sensitivity
3. Intolerance andcontraindications

1. High costs
2. Limited access

STRONG-HF primary outcomes show signiﬁcantreduction of all cause death or acute heart failure
readmissionsStudy Design

Monitoring board of the study recommended to terminate the study early
as it was considered unethical to continue with usual care.

†Hospitaldischarge
assessment of clinical status, laboratory values
and NT-proBNP concentrations

hospitalisation

Main inclusion
criteria• Main inclusion
criteria• Patient with AHF
ready to bedischarged• No or suboptimal doseof GDMT*• Pre-discharge
NT-proBNP**>1500 pg/mLHighinsensity
care

Halfoptimal
GDMT*
dose

Week 1
SafetyWeek 2
SafetyWeek 3
SafetyWeek 6
SafetyHalfoptimal
GDMTdose

Fulloptimal
GDMT
dose

Fulloptimal
GDMT
dose

Fulloptimal
GDMT
dose

Randomized 1:1
N=1078 (1800 planned)
Usual
care

Primary
endpoint

90-dayfollow-up

180-day HF
readmission orall-cause
mortality

Follow-up and therapy adjustments per
physician’s usual practice*ACEi/ARB, ARNi, BB, or MRA; **NT-proBNP criteria for persistent congestion ACEi, angiotensin-converting enzyme
inhibitors; AHF, acute heart failure; ARB, angiotensin receptor blockers; BB, beta blockers; GDMT, guideline-directed
medical therapy; HF, heart failure; MRA, mineralocorticoid receptor antagonists; NT-proBNP, N-terminal pro b-typenatriuretic peptide

Measuring NT-proBNP biomarker levels is an integral part of the treatment
strategy in STRONG-HF.

Results
The high intensity care group: 34% relative and 8.1% absolute risk reduction (ARR) in the
combination of death or heart failure readmission.14

CV (cardiovascular) death

26% lower

HF readmission

All-cause death

44% lower 16% lower

STRONG-HF study results demonstrated clear beneﬁts for acute heart failure
patients by adapting the strategy of care.

References:1

Ponikowski P, et al. ESC Heart Fail. 2014;1(1):4-25.

2Krumholz HM, et al. Circ Cardiovasc Qual Outcomes. 2009;2:407–413.

Cowie MR, et al. Improving care for patients are acute heart failure [Internet; cited 2013].
Available from:http://www.oxfordhealthpolicyforum.org/reports/acute-heart-failure/improving-care-for-patients-with-acute-heart-failure.
3

4Butler J, et al. Congest Heart Fail. 2012;18(5 Suppl 1):S1-S3.

5

Chioncel O, et al. Eur J Heart Fail. 2017;19:1242-1254;

6Granger BB, et al., J Card Fail. 2022;28:1355-1361.

7

Butler J, et al. Eur J Heart Fail. 2021;23:1334-1342.

8Greene SJ, et al., J Am Coll Cardiol. 2018;72:351-366.

9Joseph S, et al. Eur Heart J. 2021;43:908-915.

10

Damasceno A, et al., Arch Intern Med. 2012;172:1386-1394.

11Čerlinskaitė K, et al. ESC Heart Fail. 2021;8:2473-2484.

12

McDonagh TA, et al. Eur Heart J. 2021 Sep 21;42(36):3599-3726.

13

Komajda M, et al. Eur J Heart Fail. 2016;18(5):514-22.

14

Mebazaa A, et al. The Lancet. 2022; S0140-6736(22)02076-1.