Titration of Medications After Acute Heart Failure Is Safe, Tolerated, and Effective Regardless of Risk,JACC: Heart Failure

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Titration of Medications After Acute Heart Failure Is Safe, Tolerated, and Effective Regardless of Risk
JACC: Heart Failure ( IF 10.3 ) Pub Date : 2024-05-12 , DOI: 10.1016/j.jchf.2024.04.017
Andrew P Ambrosy ₁ , Alex J Chang ₂ , Beth Davison ₃ , Adriaan Voors ₄ , Alain Cohen-Solal ₅ , Albertino Damasceno ₆ , Antoine Kimmoun ₇ , Carolyn S P Lam ₈ , Christopher Edwards ₉ , Daniela Tomasoni ₁₀ , Etienne Gayat ₁₁ , Gerasimos Filippatos ₁₂ , Hadiza Saidu ₁₃ , Jan Biegus ₁₄ , Jelena Celutkiene ₁₅ , Jozine M Ter Maaten ₄ , Kamilė Čerlinskaitė-Bajorė ₁₆ , Karen Sliwa ₁₇ , Koji Takagi ₉ , Marco Metra ₁₀ , Maria Novosadova ₉ , Marianela Barros ₉ , Marianna Adamo ₁₀ , Matteo Pagnesi ₁₀ , Mattia Arrigo ₁₈ , Ovidiu Chioncel ₁₉ , Rafael Diaz ₂₀ , Peter S Pang ₂₀ , Piotr Ponikowski ₁₄ , Gad Cotter ₃ , Alexandre Mebazaa ₁₁

Affiliation

Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA; Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.
Department of Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA.
Université Paris Cité, INSERM UMR-S 942(MASCOT), Paris, France; Momentum Research Inc, Durham, North Carolina, USA; Heart Initiative, Durham, North Carolina, USA.
Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.
Université Paris Cité, INSERM UMR-S 942(MASCOT), Paris, France; Department of Cardiology, APHP Nord, Lariboisière University Hospital, Paris, France.
Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
Université de Lorraine, Nancy, INSERM, Défaillance Circulatoire Aigue et Chronique, Service de Médecine Intensive et Réanimation Brabois, CHRU de Nancy, Vandoeuvre-lès-Nancy, France.
Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands; National Heart Centre Singapore and Duke-National University of Singapore.
Momentum Research Inc, Durham, North Carolina, USA.
Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
Université Paris Cité, INSERM UMR-S 942(MASCOT), Paris, France; Department of Anesthesiology and Critical Care and Burn Unit, Saint-Louis and Lariboisière Hospitals, FHU PROMICE, DMU Parabol, APHP.Nord, Paris, France.
National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece.
Murtala Muhammed Specialist Hospital/Bayero University Kano, Kano, Nigeria.
Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland.
Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
Cape Heart Institute, Department of Medicine and Cardiology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
Department of Internal Medicine, Stadtspital Zurich, Zurich, Switzerland.
Emergency Institute for Cardiovascular Diseases "Prof. C.C.Iliescu," University of Medicine "Carol Davila," Bucharest, Romania.
Estudios Clínicos Latinoamérica, Instituto Cardiovascular de Rosario, Rosario, Argentina.
Department of Emergency Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.

Guideline-directed medical therapy (GDMT) decisions may be less affected by single patient variables such as blood pressure or kidney function and more by overall risk profile. In STRONG-HF (Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure), high-intensity care (HIC) in the form of rapid uptitration of heart failure (HF) GDMT was effective overall, but the safety, tolerability and efficacy of HIC across the spectrum of HF severity is unknown. Evaluating this with a simple risk-based framework offers an alternative and more clinically translatable approach than traditional subgroup analyses.

中文翻译：

无论风险如何，急性心力衰竭后的药物滴定都是安全、耐受且有效的

指南指导的药物治疗 (GDMT) 决策可能较少受到血压或肾功能等单个患者变量的影响，而更多地受到总体风险状况的影响。在 STRONG-HF（急性心力衰竭指南指导药物治疗的安全性、耐受性和有效性）中，以心力衰竭 (HF) GDMT 快速调整形式进行的高强度护理 (HIC) 总体上是有效的，但 HIC 在各种心力衰竭严重程度范围内的安全性、耐受性和有效性尚不清楚。与传统的亚组分析相比，使用简单的基于风险的框架对此进行评估提供了一种替代且更具临床可转化性的方法。

更新日期：2024-05-12

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