Eligibility for Rapid Up-Titration of Guideline-Directed Medical Therapy of Real-World Patients Hospitalised for Heart Failure.

INTRODUCTION AND AIMS

The 2023 Focused Update of the 2021 ESC Heart Failure (HF) Guidelines recommends the rapid up-titration (RT) of guideline-directed medical therapy (GDMT) for all patients hospitalised for HF to improve prognosis in light of the STRONG-HF trial. However, the real-world feasibility of RT and the optimal selection of suitable patients may cause difficulties as the STRONG-HF trial applied strict randomisation criteria. We aimed to assess the proportion of hospitalised HF patients suitable for RT after discharge.

METHODS

The proportion of patients eligible for RT based on the basic inclusion and exclusion criteria of the STRONG-HF trial (systolic blood pressure [SBP] ≥100 mm Hg, heart rate [HR] ≥60 min-1, serum potassium ≤5 mmol/L, estimated glomerular filtration rate [eGFR] ≥30 mL/min/1.73 m2, discharge N-terminal pro-B type natriuretic peptide [NT-proBNP] >1,500 pg/mL) was assessed in a consecutive patient cohort at a tertiary referral centre between April 01, 2021, and December 31, 2023.

RESULTS

Data from 408 consecutive patients were analysed (male: 71%; age: 62 [51-72] years; left ventricular ejection fraction: 27 [20-35]%; HF with reduced ejection fraction: 82%; hypertension: 67%; diabetes: 36%; atrial fibrillation: 47%). 78% of the patients were suitable for RT based on the SBP criterion, 93% on HR, 89% on serum potassium, and 91% on eGFR values. Thus, 60% were eligible for RT using the combined assessment of these parameters. When including the NT-proBNP value as well (60%), 34% of the cohort were eligible for RT.

CONCLUSIONS

Based on our study, the proportion of patients suitable for RT of GDMT ranged from 34% to 60% based on the basic eligibility indicators of the STRONG-HF trial. Our results highlight the strategic importance of careful selection of patients eligible for RT.