In my opinion, the biggest news from #AHA22 for the heart failure community was the results of #STRONGHF. @AlexMebazza, the trial's principal investigator, presented the results. The following thread summarizes his presentation. @AHAScience
#STRONGHF was conducted to determine whether rapid/high-intensity uptitrations of doses of heart failure #GDMT would be safe and effective compared with usual care. @AlexMebazaa @AHAScience #AHA22
Patients received high-intensity care resulting in the successful administration of beta-blockers, RAS inhibitors, & mineralocorticoid receptor antagonists w/in 6 weeks. The primary outcome was hospitalization for HF or all-cause mortality w/in 180 days. @AlexMebazaa #AHA22
Approximately 50% of patients in the intervention arm were on full optimal doses of BB and RASi at 90 days, while more than 80% of patients were on full optimal doses of MRA at 90 days. As compared to the usual care, this was significantly better. @AlexMebazaa @AHAScience #AHA22
More than 80% of the patients in the intervention arm received half to full optimal doses of BB, RASi, and MRA after 90 days. Among those taking usual care, only MRA was administered at the same dose and frequency. @AlexMebazaa @AHAScience #AHA22
High-intensity care resulted in less edema, a lower NYHA class, and a lower natriuretic peptide level, among other outcomes - all without a significant difference in renal function. @AlexMebazaa @AHAScience #AHA22
As the primary endpoint, an absolute reduction of 8.1% in HF readmissions and all-cause mortality was observed between high intensity and usual care at 180 days. @AlexMebazaa @AHAScience #AHA22
In the absence of deaths due to COVID, the absolute risk reduction increased to 8.9%. In addition, when looking at all-cause mortality, the curves began to split 60 days after randomization. @AlexMebazaa @AHAScience #AHA22
It was observed that high-intensity care achieved the primary end-point regardless of LVEF, i.e., <40 or >40. @AlexMebazaa @AHAScience #AHA22
The rapid up-titration of HF therapies under close follow-up reduces HF hospitalizations, reduces the risk of all-cause mortality, and improves the quality of life of patients living with #heartfailure. @AlexMebazaa @AHAScience #AHA22

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More from @MHBeasleyMD

Apr 18, 2020
#HFpEF was a hot topic this morning at @CanHFSociety #HFupdate20! Dr. @KSharmaMD of @HopkinsMedicine spoke on the process of making a correct HFpEF diagnosis - something which most internists and even cardiologists struggle with according to data which was shared. 1/6
In the "real world" @KSharmaMD makes her diagnosis by identifying patients with a clinical heart failure syndrome, LVEF > 50% and objective evidence of cardiac disease (⬆️BNP, LVH, diastolic dysfunction, PCWP or LVEDP > 15). Dr. Sharma also alerted us to be mindful of the 2/6
presence of "exercise-induced HFpEF" - a phenotype with normal or mildly abnormal filling pressures at rest (i.e. LVEDP, PCWP, mPAP), but severe elevation of such pressures with activity. Her gold standard is a level three stress test, which is a 3/6
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