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Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure (STRONG-HF): a multinational, open-label, randomised, trial
Open accessAbstract
Background There is a paucity of evidence for dose and pace of up-titration of guideline-directed medical therapies after admission to hospital for acute heart failure.Methods In this multinational, open-label, randomised, parallel-group trial (STRONG-HF), patients aged 18-85 years admitted to hospital with acute heart failure, not treated with full doses of guideline-directed drug treatment, were recruited from 87 hospitals in 14 countries. Before discharge, eligible patients were randomly assigned (1:1), stratified by left ventricular ejection fraction (≤40% vs >40%) and country, with blocks of size 30 within strata and randomly ordered sub-blocks of 2, 4, and 6, to either usual care or high-intensity care. Usual care followed usual local practice, and high-intensity care involved the up-titration of treatments to 100% of recommended doses within 2 weeks of discharge and four scheduled outpatient visits over the 2 months after discharge that closely monitored clinical status, laboratory values, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations. The primary endpoint was 180-day readmission to hospital due to heart failure or all-cause death. Efficacy and safety were assessed in the intention-to-treat (ITT) population (ie, all patients validly randomly assigned to treatment). The primary endpoint was assessed in all patients enrolled at hospitals that followed up patients to day 180. Because of a protocol amendment to the primary endpoint, the results of patients enrolled on or before this amendment were down-weighted. This study is registered with ClinicalTrials.gov, NCT03412201, and is now complete.Findings Between May 10, 2018, and Sept 23, 2022, 1641 patients were screened and 1078 were successfully randomly assigned to high-intensity care (n=542) or usual care (n=536; ITT population). Mean age was 63·0 years (SD 13·6), 416 (39%) of 1078 patients were female, 662 (61%) were male, 832 (77%) were White or Caucasian, 230 (21%) were Black, 12 (1%) were other races, one (<1%) was Native American, and one (<1%) was Pacific Islander (two [<1%] had missing data on race). The study was stopped early per the data and safety monitoring board's recommendation because of greater than expected between-group differences. As of data cutoff (Oct 13, 2022), by day 90, a higher proportion of patients in the high-intensity care group had been up-titrated to full doses of prescribed drugs (renin-angiotensin blockers 278 [55%] of 505 vs 11 [2%] of 497; β blockers 249 [49%] vs 20 [4%]; and mineralocorticoid receptor antagonists 423 [84%] vs 231 [46%]). By day 90, blood pressure, pulse, New York Heart Association class, bodyweight, and NT-proBNP concentration had decreased more in the high-intensity care group than in the usual care group. Heart failure readmission or all-cause death up to day 180 occurred in 74 (15·2% down-weighted adjusted Kaplan-Meier estimate) of 506 patients in the high-intensity care group and 109 (23·3%) of 502 patients in the usual care group (adjusted risk difference 8·1% [95% CI 2·9-13·2]; p=0·0021; risk ratio 0·66 [95% CI 0·50-0·86]). More adverse events by 90 days occurred in the high-intensity care group (223 [41%] of 542) than in the usual care group (158 [29%] of 536) but similar incidences of serious adverse events (88 [16%] vs 92 [17%]) and fatal adverse events (25 [5%] vs 32 [6%]) were reported in each group.Interpretation An intensive treatment strategy of rapid up-titration of guideline-directed medication and close follow-up after an acute heart failure admission was readily accepted by patients because it reduced symptoms, improved quality of life, and reduced the risk of 180-day all-cause death or heart failure readmission compared with usual care.Funding Roche Diagnostics.
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In the citing paper
“In addition, dapagliflozin reduced all-cause mortality (HR 0.83; 95% CI, 0.71-0.97)and improved symptoms, physical function, and quality of life in patients with HFrEF.491,492”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [492]
Experimental — accuracy not yet measuredIn the citing paper
“Therapy with dapagliflozin 10 mg o.d. vs. placebo reduced the risk of the primary outcome, a composite of worsening HF (hospitalization or an urgent visit resulting in i.v.therapy for HF) or CV death, by 26% (HR 0.74; 95% CI, 0.65-0.85).”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [492]
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Cites
2021 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure
Authors/Task Force Members:, McDonagh, T. A., Metra, M., Adamo, M., Gardner, R. S., Baumbach, A., Böhm, M., Burri, H., Butler, J., Čelutkienė, J., et al. (2022) · European Journal of Heart Failure · doi:10.1002/ejhf.2333 · Cited by 2,356
Self-citationSotagliflozin in patients with diabetes and recent worsening heart failure
Bhatt, D. L., Szarek, M., Steg, P. G., Cannon, C. P., Leiter, L. A., McGuire, D. K., Lewis, J. B., Riddle, M. C., Voors, A. A., Metra, M., et al. (2021) · New England Journal of Medicine · doi:10.1056/nejmoa2030183 · Cited by 1,868
Self-citationMedical Therapy for Heart Failure With Reduced Ejection Fraction
Greene, S. J., Butler, J., Albert, N. M., DeVore, A. D., Sharma, P. P., Duffy, C. I., Hill, C. L., McCague, K., Mi, X., Patterson, J. H., et al. (2018) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.04.070 · Cited by 1,322
Voors, A. A., Angermann, C. E., Teerlink, J. R., Collins, S. P., Kosiborod, M., Biegus, J., Ferreira, J. P., Nassif, M. E., Psotka, M. A., Tromp, J., et al. (2022) · Nature Medicine · doi:10.1038/s41591-021-01659-1 · Cited by 951
Self-citationChioncel, O., Mebazaa, A., Harjola, V., Coats, A. J. S., Piepoli, M. F., Crespo‐Leiro, M. G., Laroche, C., Seferovic, P. M., Anker, S. D., Ferrari, R., et al. (2017) · European Journal of Heart Failure · doi:10.1002/ejhf.890 · Cited by 597
Self-citationThe Causes, Treatment, and Outcome of Acute Heart Failure in 1006 Africans From 9 Countries
Damasceno, A. A. M., Mayosi, B. M., Sani, M. U., Ogah, O. S., Mondo, C. K., Ojji, D. B., Dzudié, A., Kouam, C. K., Suliman, A., Schrueder, N., et al. (2012) · Archives of Internal Medicine · doi:10.1001/archinternmed.2012.3310 · Cited by 564
Self-citationFelker, G. M., Anstrom, K. J., Adams, K. F., Ezekowitz, J. A., Fiuzat, M., Miller, N. H., Januzzi, J. L., Mark, D. B., Piña, I. L., Passmore, G., et al. (2017) · JAMA · doi:10.1001/jama.2017.10565 · Cited by 554
Jaarsma, T. (2008) · Archives of Internal Medicine · doi:10.1001/archinternmed.2007.83 · Cited by 511
Packer, M., Anker, S. D., Butler, J., Filippatos, G., Ferreira, J. P., Pocock, S. J., Carson, P., Anand, I., Doehner, W., Haass, M., et al. (2021) · Circulation · doi:10.1161/circulationaha.120.051783 · Cited by 435
Self-citationPitt, B., White, H. D., Nicolau, J. C., Martínez, F. A., Gheorghiade, M., Aschermann, M., van Veldhuisen, D. J., Zannad, F. M., Krum, H., Mukherjee, R., et al. (2005) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2005.04.038 · Cited by 396
Cited by
Sorted by citations
Items 301–400 of 1,000
Lanier, C., Brumit, J. C., Tharp, J. L., Crawford, J., White, K. M., Wilson, V., & Covert, K. L. (2025) · American Journal of Health-System Pharmacy · doi:10.1093/ajhp/zxaf025 · Cited by 7
Mazzotta, R., Garofalo, M., Salvi, S., Orlandi, M., Marcaccini, G., Susini, P., Checchi, L., Palazzuoli, A., Mario, C. D., Pieroni, M., et al. (2025) · ESC Heart Failure · doi:10.1002/ehf2.15293 · Cited by 7
“10 Although SGLT2 inhibitors were not evaluated in this trial, this recommendation also includes empagli fl ozin or dapagli fl ozin based on recent evidence.”
Obesity and inflammation in chronic and acute heart failure
Cotter, G., Petrie, M. C., Butler, J., Davison, B. A., Chioncel, O. D., Biegus, J., Pagnesi, M., Voors, A. A., Metra, M., Ponikowski, P. P., et al. (2025) · Heart Failure Reviews · doi:10.1007/s10741-025-10518-x · Cited by 9
“The STRONG-HF study has demonstrated that the early introduction of higher doses of blockers of the renin-angiotensin (RAS) and adrenergic systems (the so called guideline directed medical therapy (GDMT)) was associated with reduced congestion, improved QoL, and a reduction in HF events [36–38].”
Self-citationAlhakem, H., Murphy, A., Fusco, L., McQueen, G., Pearse, S., Barrett, J., Linnard, D., & Khan, S. (2025) · PLOS Digital Health · doi:10.1371/journal.pdig.0000868 · Cited by 6
Berge, K., Schirmer, H., Øvrebotten, T., Nahoui, H., Gullestad, L. L., Ingul, C. B., Hole, T., Mo, R., Larsby, K. E., Norekvål, T. M., et al. (2025) · ESC Heart Failure · doi:10.1002/ehf2.15337 · Cited by 7
“25,26 Our results further builds on these results which may seem to contrast fi ndings from clinical trials such as PARADIGM-HF.”
Esser, R., Mondragon, A., Larbaneix, M., Esteban, M., Farges, C., Nisse-Durgeat, S., Maurou, O., & Harboun, M. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15020749 · Cited by 7
“…trials and implementation studies have shown that structured coordination, early optimisation of care after hospitalisation, and clear clinical accountability are associated with improved outcomes and reduced rehospitalisation in HF populations, including older and more complex patients [41,42].”
Navarese, E. P., Gorog, D. A., Markides, R. I. L., Koolaji, S., Kereiakes, D. J., Kubica, J., İsgender, M., Lüscher, T. F., & Gorog, D. A. (2026) · JACC Advances · doi:10.1016/j.jacadv.2026.102588 · Cited by 7
Ichihara, Y. K., Kohsaka, S., Kisanuki, M., Sandhu, A. T., & Kawana, M. (2023) · Journal of Cardiology · doi:10.1016/j.jjcc.2023.07.019 · Cited by 7
Yan, C. L., Erben, A., & Sancassani, R. B. (2023) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2023.11.005 · Cited by 7
Natriuretic peptide testing strategies in heart failure: A 2023 update
Chaikijurajai, T., Rincon-Choles, H., & Tang, W. H. W. (2023) · Advances in clinical chemistry · doi:10.1016/bs.acc.2023.11.005 · Cited by 7
Cardelli, L. S., Cherbi, M., Huet, F., Schurtz, G., Bonnefoy‐Cudraz, E., Gerbaud, É., Bonello, L., Leurent, G., Puymirat, É., Casella, G., et al. (2023) · Pharmaceuticals · doi:10.3390/ph16121740 · Cited by 7
Uemura, Y., Shibata, R., Sawada, K., Ishikawa, S., Takemoto, K., Murohara, T., & Watarai, M. (2024) · Heart and Vessels · doi:10.1007/s00380-024-02366-w · Cited by 7
“The evolution of pharmacotherapy for HF, based on the results of landmark trials, along with the implementation of multiple medication classes and early up-titration have improved the prognosis in HF patients and the quality of their life [3–5].”
Kourek, C., Briasoulis, Α., Papamichail, A., Xanthopoulos, A. V., Tsougos, E., Farmakis, D. T., & PARASKEVAIDIS, I. A. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms25063113 · Cited by 11
“…therapy with β -blockers, ARNIs, SGLT2 inhibitors, and MRAs should be initiated during hospital stay and uptitrated to maximum doses within 6 weeks after discharge according to the STRONG HF trial [8], thus improving survival by approximately 8 years for a 55-year-old heart failure patient [9].”
MethodEzhumalai, B., Modi, R., Panchanatham, M., & Kaliyamoorthy, D. (2024) · Indian Heart Journal · doi:10.1016/j.ihj.2024.07.005 · Cited by 10
“89 An intensive approach involving the initiation and rapid increase of evidence-based treatments before discharge, along with frequent and thorough follow-up visits in the first 6 weeks after HHF, is recommended to lower the risk of rehospitalization or death from HF. 57”
BackgroundDigital Solutions for the Optimization of Pharmacologic Therapy for Heart Failure
DeVore, A. D., Walsh, M. N., Vardeny, O., Albert, N. M., & Desai, A. S. (2025) · JACC Heart Failure · doi:10.1016/j.jchf.2024.10.014 · Cited by 7
Berg, D. D., Patel, S. M., Haller, P. M., Bělohlávek, J., Desai, A. S., Dróżdż, J., Inzucchi, S. E., McMurray, J. J. V., Merkely, B. P., O’Meara, E., et al. (2025) · JACC Heart Failure · doi:10.1016/j.jchf.2025.03.014 · Cited by 8
Villaschi, A., Basile, C., Benson, L., Gatti, P., Abraham, W. T., Böhm, M., Bozkurt, B., Butler, J., Condorelli, G., Linde, C. M., et al. (2025) · JACC Heart Failure · doi:10.1016/j.jchf.2025.102515 · Cited by 7
Self-citationHypotension at heart failure discharge: Should it be a limiting factor for drug titration?
Melendo‐Viu, M., Dobarro, D., Marchán-López, Á., Domínguez, L. M., Raposeiras‐Roubín, S., Abu‐Assi, E., Cardero-González, C., Pérez-Expósito, L., Fernández, M. C., Barcía, J. A. P., et al. (2023) · International Journal of Cardiology · doi:10.1016/j.ijcard.2023.05.007 · Cited by 7
Bauersachs, J. K., & Soltani, S. (2023) · European Heart Journal · doi:10.1093/eurheartj/ehad540 · Cited by 8
Heart failure registries – Future directions
Pol, T., Karlström, P., & Lund, L. H. (2023) · Journal of Cardiology · doi:10.1016/j.jjcc.2023.10.006 · Cited by 7
Ferrannini, G., Benson, L., Lautsch, D., Dahlström, U., Lund, L. H., Savarese, G., & Carrero, J. J. (2023) · ESC Heart Failure · doi:10.1002/ehf2.14613 · Cited by 6
Severino, P., D’Amato, A., Prosperi, S., Mariani, M. V., Myftari, V., Francia, A. L., Cestiè, C., Tomarelli, E., Manzi, G., Birtolo, L. I., et al. (2024) · American Journal of Cardiovascular Drugs · doi:10.1007/s40256-024-00660-6 · Cited by 7
“Safety was assessed by means of frequent visits, including clinical and laboratory check-ups [9].”
BackgroundMethodInfluentialGuideline-Recommended Therapy Following Hospitalization for Heart Failure
Averbuch, T., Greene, S. J., & Spall, H. G. C. V. (2023) · JACC Heart Failure · doi:10.1016/j.jchf.2023.07.022 · Cited by 7
Improving Utilization of Guideline-Directed Medical Therapy for Heart Failure
Baksh, G., Haydo, M., Frazier, S., Reesor, H., Kunselman, A. R., Ahmed, S. R., Contreras, C., & Ali, O. A. (2024) · The Journal for Nurse Practitioners · doi:10.1016/j.nurpra.2024.105108 · Cited by 6
Sze, S., Thaitirarot, C., Krishnan, S., Chan, D., Nicolson, W., Squire, I. B., Clayton, L., & Loke, I. W. (2025) · Clinical Medicine · doi:10.1016/j.clinme.2025.100296 · Cited by 6
“STRONG HF also did not include the use of SGLT2 inhibitors, which only subsequently become part of standard GDMT. Nonetheless, in real-world clinical practice, timely initiation and up-titration of life-saving medications to target doses in HFrEF patients remain challenging.”
InfluentialDeVore, A. D., Xie, J., Etters, L., Rael, E. L., Wibowo, S., HAO, C., Majmudar, M. D., Hernandez, A. F., Fonarow, G. C., & Desai, A. S. (2025) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2025.02.018 · Cited by 6
López-Vilella, R., Gómez-Otero, I., Trenado, V. D., García-Vega, D., Otero-García, Ó., Dolz, L. M., González-Juanatey, J., & Bonet, L. A. (2025) · Life · doi:10.3390/life15040526 · Cited by 7
“In the STRONG-HF clinical trial, the age was even lower, at 63 years, with 61% male participants [13].”
Hospital-at-Home care for acute heart failure: Feasibility and safety pilot
Bosman, J. B., Jager, F. J. P., Badings, E., van Wijngaarden, J., & Klomp, W. W. J. (2025) · Netherlands Heart Journal · doi:10.1007/s12471-025-01949-0 · Cited by 6
“Also, in the light of the 2022 STRONG-HF study [12], treatment regimens may have become more intense over time.”
Early in-hospital use of SGLT2i in heart failure patients with ischemic etiology
Severino, P., D’Amato, A., Myftari, V., Prosperi, S., Mariani, M. V., Colombo, L., Germanò, R., Marek‐Iannucci, S., Cestiè, C., Ferranti, F. F. F., et al. (2025) · Cardiovascular Drugs and Therapy · doi:10.1007/s10557-025-07714-0 · Cited by 6
“Furthermore, when initiated early, they also improve short term outcomes in patients hospitalized due to acute HF, improving also congestion status, renal function and symptoms [15, 16].”
Guideline-Directed Medical Therapy Use in the STRONG-HF Trial
Zhang, X., Davison, B. A., Adamo, M., Arrigo, M., Biegus, J., Chioncel, O., Solal, A. C., Cotter, G., Edwards, C., Kimmoun, A., et al. (2025) · Circulation Heart Failure · doi:10.1161/circheartfailure.124.012716 · Cited by 6
Self-citationRuiz, S., Vicente, M., Ruiz-Rodriguez, P., Linás-Alonso, A. M., Moré, S. V., Farré, N., Tornero, L. C. B., Murillo, R. O. M., Vime‐Jubany, J., Badosa, N., et al. (2025) · European Journal of Cardiovascular Nursing · doi:10.1093/eurjcn/zvaf161 · Cited by 8
Exploring Medication Adherence in Heart Failure From a Patient Perspective: A Qualitative Study
Gunnthorsdottir, I., Ingimarsdóttir, I. J., Gunnarsdóttir, A. I., Andersen, K. K., Svansdóttir, E., Thrainsdottir, I. S., Forsyth, P., & Almarsdóttir, A. B. (2025) · Research in Social and Administrative Pharmacy · doi:10.1016/j.sapharm.2025.06.079 · Cited by 6
Miró, Ò., Chioncel, O., Mebazaa, A., Sato, N., Butler, J., Davison, B. A., Biegus, J., Pagnesi, M., Ambrosy, A. P., Savarese, G., et al. (2025) · European Journal of Emergency Medicine · doi:10.1097/mej.0000000000001270 · Cited by 6
Self-citationScoma, C. B., Lee, D. H., Money, D., Eichelberger, G. S., Usmani, A., Cohen, A. J., & Fernandez, J. (2023) · Journal of Cardiovascular Pharmacology · doi:10.1097/fjc.0000000000001532 · Cited by 6
Wohlfahrt, P., Jenča, D., Melenovský, V., Stehlik, J., Mrázková, J., Šramko, M., Kotrč, M., Želı́zko, M., Adámková, V., Pitha, J. V., et al. (2024) · European Journal of Preventive Cardiology · doi:10.1093/eurjpc/zwae114 · Cited by 6
Renal Sodium Avidity in Heart Failure
den Eynde, J. V., & Verbrugge, F. H. (2024) · Cardiorenal Medicine · doi:10.1159/000538601 · Cited by 6
Nouhravesh, N., Gunn, A. H., Cyr, D. D., Hernandez, A. F., Morrow, D. A., Velazquez, E. J., Ward, J. H., Sarwat, S., Sharma, K., WILLIAMSON, K. M., et al. (2025) · European Journal of Heart Failure · doi:10.1002/ejhf.3579 · Cited by 6
Prevalence and prognostic value of atrial fibrillation in patients with cardiac sarcoidosis
Fujimoto, Y., Matsue, Y., Maeda, D., Dotare, T., Sunayama, T., Iso, T., Nakamura, Y., Singh, Y. S., Akama, Y., Yoshioka, K., et al. (2023) · European Heart Journal Open · doi:10.1093/ehjopen/oead100 · Cited by 6
“19,20 We also evaluated all-cause death and HF hospitalization as exploratory endpoints.”
BackgroundKapłon‐Cieślicka, A., Vardas, P. E., Grabowski, M., & Lelonek, M. (2023) · Kardiologia Polska · doi:10.33963/v.kp.97062 · Cited by 6
Driscoll, A. L., Meagher, S., Kennedy, R., & Currey, J. (2024) · The Journal of Cardiovascular Nursing · doi:10.1097/jcn.0000000000001068 · Cited by 6
Ahmad, F. S., Ahmad, T., & Allen, L. A. (2023) · Circulation Heart Failure · doi:10.1161/circheartfailure.122.010309 · Cited by 7
Rapid and Intensive Guideline-Directed Medical Therapy for Heart Failure
Fonarow, G. C., & Greene, S. J. (2023) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2023.04.006 · Cited by 6
Navigating negative trials in acute heart failure: insights and implications
Freund, Y., & Miró, Ò. (2024) · European Journal of Emergency Medicine · doi:10.1097/mej.0000000000001152 · Cited by 6
Socio-Economic Status and the Effect of Guideline-Directed Medical Therapy in the STRONG-HF Study
Damasceno, A., Saidu, H., Cotter, G., Davison, B. A., Edwards, C., Čelutkienė, J., Adamo, M., Arrigo, M., Barros, M., Biegus, J., et al. (2025) · ESC Heart Failure · doi:10.1002/ehf2.15156 · Cited by 5
“The study design and main results have been previously published, 12 – 14 showing that HIC was safe and effective in reducing 180-day HF readmission or death compared with UC.”
Self-citationTakaoka, Y., Rahman, M., Asano, T., Kijima, Y., & Aoki, J. (2025) · Circulation Reports · doi:10.1253/circrep.cr-25-0003 · Cited by 5
Çelik, A., Öztürk, G. Z., Çavuşoğlu, Y., Ardıç, C., Nalbantgil, S., Arica, S. G., Temizhan, A., Altay, H., Yılmaz, M. B., Özsarı, H., et al. (2025) · Balkan Medical Journal · doi:10.4274/balkanmedj.galenos.2025.2024-12-110 · Cited by 7
Görenek, B., Wijnmaalen, A. P., Goette, A., Mert, G. Ö., Porter, B., Gustafsson, F., Dan, G., Ector, J., Stuehlinger, M., Spartalis, Μ., et al. (2025) · European Journal of Heart Failure · doi:10.1002/ejhf.3645 · Cited by 5
“53 Despite a strong effect of total mortality reduction, ACEi did not significantly decrease the risk of SCD. 54 In a sub-analysis from PARADIGM-HF, 55 sacubitril/valsartan reduced SCD risk regardless of ICD use.”
Self-citationLeiner, J., König, S., Nitsche, A., Hohenstein, S., Nagel, J., Seyfarth, M., Baberg, H. T., Lauten, A., Neuser, H., Staudt, A., et al. (2025) · ESC Heart Failure · doi:10.1002/ehf2.15266 · Cited by 6
“48,53 With the H 2 -registry, we have established the infrastructure for a nationwide HF registry with a target enrolment of 4000 patients, while by the end of 2023, 2361 patients with acute and chronic HF have already been enrolled in 10 active study centres.”
Bánfi‐Bacsárdi, F., Ráduly, A. P., Borbély, A., Nyolczas, N., Szilágyi, A., Gergely, T. G., Forrai, Z., Papp, J., Rátosi, O., Rácz, T., et al. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14103611 · Cited by 5
“Without a doubt, the STRONG-HF trial, published in 2022, led to a paradigm shift and can be declared a practice-changer in the therapy optimisation routine of HF [16].”
InfluentialGioli‐Pereira, L., Katsuyama, E. S., Fukunaga, C. K., Falco, W., Padovese, C. C. G., Melo, R. H., Melo, E. D. S. A., Papp, S. E. R., & Bacal, F. (2025) · Clinical Cardiology · doi:10.1002/clc.70165 · Cited by 5
Demir, E., Köse, M. R., Şimşek, E., Orman, M. N., Zoghi, M., Gürgün, C., & Nalbantgil, S. (2025) · Scientific Reports · doi:10.1038/s41598-025-09074-z · Cited by 5
“Data analysis was conducted using IBM SPSS Statistics version 28.0 and Medcalc 19.”
InfluentialPark, J., Park, C. S., Rhee, T., Choi, H., Choi, H., Lee, H., Park, J., Yoon, Y. E., Lee, S., Kim, Y.-J., et al. (2025) · PLoS ONE · doi:10.1371/journal.pone.0328971 · Cited by 7
“…ARNI dosing in real-world populations [8–10], our findings highlight the importance of proper up-titration to the target ARNI dose among patients with tolerable on-treatment BP. Recently, the safety and efficacy of high-intensity care with rapid up-titration for HF medications was examined [21].”
Freedman, G., Watt, R., Chowdhury, E., Quinlan, K., Eccleston, D. S., Driscoll, A. L., Theuerle, J. D., & Kearney, L. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14155371 · Cited by 5
“Furthermore, recent data from the STRONG-HF trial demonstrated the safety of the early escalation of therapy in reducing the risk of death and readmission for HF, and this is increasingly influencing medication sequencing practices [8–10].”
Jung, M., Lee, S. Y., Cho, Y. H., Bae, D., Lee, S., Lee, C. J., Son, J., Cho, J. Y., & Kim, E. J. (2025) · International Journal of Heart Failure · doi:10.36628/ijhf.2025.0037 · Cited by 5
“10) This trial demonstrated that early, intensive up-titration of GDMT within weeks after hospital discharge substantially reduced 180-day all-cause mortality and HF readmissions.”
Verelst, F. R., Zagorski, B., Averbuch, T., Bagur, R., Granger, C. B., Gevaert, A. B., & Spall, H. G. C. V. (2025) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2025.08.022 · Cited by 6
Aguilera, J. L., Armijo, J. P., Muñoz-Villarreal, A. B., Cepas-Sosa, A., Luque-Serrano, L. M., Caño, N. A., Campos, G. M. H., Martin-Diaz, J. D., Manzanares, R. G., Castillo-Dominguez, J. C., et al. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14186681 · Cited by 5
“This is also evident in the ETIFIC study [10], which was a multicentre randomised clinical trial testing the non-inferiority of drug titration by NSHF compared to cardiologists.”
InfluentialCardiovascular disease epidemiology and management in the elderly and very elderly
Galati, G., Андреевна, Г. О., Dacquino, G. M., Bravo, F. F., Genovese, L., & Pedretti, R. F. E. (2025) · European Journal of Preventive Cardiology · doi:10.1093/eurjpc/zwaf470 · Cited by 6
Shlyakhto, E. V., Belenkov, Y. N., Boytsov, S. A., Вадимовна, В. С., Galyavich, A. S., Глезер, М. Г., Звартау, Н. Э., Kobalava, Z. D., Lopatin, Y. M., VIu, M., et al. (2025) · Russian Journal of Cardiology · doi:10.15829/1560-4071-2025-6517 · Cited by 5
Keshvani, N., Coellar, J. D., Patel, M. J., Bustillo-Rubio, M., Ruiz, E., Gracia, L., Agarwal, A., Wang, T. J., Kitzman, H. E., & Pandey, A. (2025) · Circulation Population Health and Outcomes · doi:10.1161/circoutcomes.125.012834 · Cited by 5
Yokawa, J., Nishikawa, T., Shimojima, M., Nakamura, M., Amino, Y., Sato, K., Koshida, Y., & Taniguchi, T. (2025) · BMC Cardiovascular Disorders · doi:10.1186/s12872-025-05311-5 · Cited by 5
2025 ESC/EACTS Guidelines for the management of valvular heart disease
Praz, F., Borger, M. A., Lanz, J., Cuartas, M. M., Abreu, A., Adamo, M., Marsan, N. A., Barili, F., Bonaros, N. E., Cosyns, B., et al. (2025) · European Heart Journal - Valvular and Structural Heart Disease · doi:10.1093/ehjvshd/xwag001 · Cited by 6
Self-citationFerrannini, G., Musella, F., Benson, L., Valente, V., Lindberg, F., Boccalatte, M., Cabrera, C. C., Dahlström, U., Lund, L. H., Stolfo, D., et al. (2026) · European Heart Journal - Quality of Care and Clinical Outcomes · doi:10.1093/ehjqcco/qcag063 · Cited by 5
“23,24 Slight age discrepancies were reported, with lower prescription rates in older patients with HFpEF.”
Prosenz, J., Stättermayer, M., Riedl, F., & Maieron, A. (2023) · Scandinavian Journal of Gastroenterology · doi:10.1080/00365521.2023.2183734 · Cited by 5
Li, Y., Wang, C., Hung, C., Wu, Y., Hsu, C., Tsou, Y., Wang, C., Wu, C., Lin, P., Chang, H., et al. (2024) · PubMed Central · doi:10.6515/acs.202403_40(2).20240206a · Cited by 5
Paton, M. F., Gierula, J., Jamil, H. A., Straw, S., Lowry, J. E., Byrom, R., Slater, T. A., Fellows, A., Gillott, R., Chumun, H., et al. (2024) · Nature Medicine · doi:10.1038/s41591-024-03265-3 · Cited by 5
Therapeutic novelties in acute heart failure and practical perspectives
Deniau, B., Asakage, A., Takagi, K., Gayat, É., Mebazaa, A., & Rakisheva, A. (2025) · Anaesthesia Critical Care & Pain Medicine · doi:10.1016/j.accpm.2025.101481 · Cited by 5
Self-citationNouhravesh, N., Cyr, D. D., Hernandez, A. F., Morrow, D. A., Velazquez, E. J., Ward, J. H., Sarwat, S., Sharma, K., WILLIAMSON, K. M., Starling, R. C., et al. (2025) · Journal of the American Heart Association · doi:10.1161/jaha.124.037899 · Cited by 6
“15,16 As such, a post hoc analyses of PARAGON-HF revealed that initiating treatment with Sac/Val early postdischarge was linked to a greater reduction in the risk of HF hospitalization and cardiovascular death in patients with HF with an EF ≥45%.”
Khandwalla, R. M., Shvartser, A., Zimmer, R. J., Chukumerije, M. T., Share, M., Zadikany, R. H., Farkouh, M. E., Fonarow, G. C., Elad, Y., & Kittleson, M. M. (2025) · JACC Heart Failure · doi:10.1016/j.jchf.2025.03.045 · Cited by 5
STRONG start for implementation of guideline-directed medical therapies
Cox, Z. L., & Lindenfeld, J. M. (2022) · The Lancet · doi:10.1016/s0140-6736(22)02372-8 · Cited by 5
Tabella, E., Correale, M., Alcidi, G., Pugliese, R., Ioannoni, S., Romano, M., Palmieri, G., Biase, M. D., Brunetti, N. D., & Iacoviello, M. (2023) · Clinics and Practice · doi:10.3390/clinpract13050090 · Cited by 5
“The capacity to introduce all four classes of medications and adjust their doses has profound clinical implications, as recently demonstrated in the STRONG-HF trial [20].”
BackgroundMwita, J. C., Joubert, A., Saidu, H., Sani, M. U., Damasceno, A. A. M., Mocumbi, A. O., Sinxadi, P., Viljoen, C. A., Hoevelmann, J., Gebreyesus, M. S., et al. (2023) · International Journal of Cardiology Cardiovascular Risk and Prevention · doi:10.1016/j.ijcrp.2023.200213 · Cited by 5
Self-citationJarjour, M., & Ducharme, A. (2023) · Drugs in Context · doi:10.7573/dic.2023-5-6 · Cited by 5
“Initiation and up-titration of recommended evidence-based therapies in a timely matter is the fundamental basis of the management of patients with HFrEF to improve outcomes 39 but remain suboptimal in clinical practice.”
BackgroundEndubaeva, G. V., Solovyova, A. E., Medvedev, A. E., Kurbanova, M. M., Kogan, E. I., Gorbacheva, T. V., Yazenok, A. V., Звартау, Н. Э., & Вадимовна, В. С. (2023) · Russian Journal of Cardiology · doi:10.15829/1560-4071-2023-5621 · Cited by 5
2023 focused update of the 2021 ESC heart failure guidelines: Key messages for clinical practice
Tomasoni, D., Cannata, A. N., Adamo, M., & Metra, M. (2024) · European Journal of Clinical Investigation · doi:10.1111/eci.14163 · Cited by 5
“16 A close assessment of systolic blood pressure, heart rate, renal function, potassium levels and changes in NT-proBNP during rapid up-titration is recommended to ensure safety of GDMT optimization.”
BackgroundSelf-citationFarmakis, D. T., Davison, B. A., Fountoulaki, K., Liori, S., Chioncel, O., Metra, M., Čelutkienė, J., Solal, A. C., Damasceno, A. A. M., Díaz, R., et al. (2024) · JACC Heart Failure · doi:10.1016/j.jchf.2024.06.010 · Cited by 5
Self-citationMachine learning to optimize use of natriuretic peptides in the diagnosis of acute heart failure
Doudesis, D., Lee, K. K., Anwar, M., Singer, A. J., Hollander, J. E., Chenevier‐Gobeaux, C., Claessens, Y.-É., Wussler, D. N., Weil, D., Kozhuharov, N., et al. (2025) · European Heart Journal Acute Cardiovascular Care · doi:10.1093/ehjacc/zuaf051 · Cited by 5
“39 – 41 Patients with a low-probability of acute heart failure could be discharged from the Emergency Department safely or investigated for other differential diagnoses more promptly resulting in cost savings for healthcare institutions.”
Advances in Clinical Cardiology 2022: A Summary of Key Clinical Trials
Savage, P., Cox, B., Shahmohammadi, M., Foster, J., & Menown, I. B. A. (2023) · Advances in Therapy · doi:10.1007/s12325-023-02502-4 · Cited by 6
“The STRONG-HF (Safety, Tolerability and Efficacy of Rapid Optimization, Helped by NT-proBNP Testing, of Heart Failure Therapies) trial [87] randomised 1078 patients admitted to hospital with acute HF to rapid up-titration (achieving full recommended doses within 2 weeks of discharge) versus usual care.”
MethodSEC Working Group for the 2023 update of the 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure and SEC Guidelines Committee (2023) · Revista Española de Cardiología (English Edition) · doi:10.1016/j.rec.2023.10.009 · Cited by 5
Ambrosy, A. P., Chang, A. J., Davison, B. A., Voors, A. A., Solal, A. C., Damasceno, A., Kimmoun, A., Lam, C. S. P., Lund, L. H., Edwards, C., et al. (2024) · JACC Heart Failure · doi:10.1016/j.jchf.2024.04.017 · Cited by 7
Self-citationRodrigues, A. S., de Castilho, F. M., Ribeiro, A. J. F., Passaglia, L. G., Taniguchi, F. P., & Ribeiro, A. L. P. (2024) · Arquivos Brasileiros de Cardiologia · doi:10.36660/abc.20230699 · Cited by 5
Rapid Sequence Initiation of Device Therapy in Heart Failure
Salah, H. M., Butler, J., & Fudim, M. (2023) · JACC Advances · doi:10.1016/j.jacadv.2023.100316 · Cited by 5
Making STRONGer the transition phase: personalized GDMT through NT-proBNP monitoring
Bayés‐Genís, A., & Pascual-Figal, D. A. (2023) · European Heart Journal · doi:10.1093/eurheartj/ehad356 · Cited by 5
Serial NT-proBNP Measurements and Implementation of Guideline-Directed Medical Therapy
Khan, M. S., Greene, S. J., & DeVore, A. D. (2024) · JACC Heart Failure · doi:10.1016/j.jchf.2024.01.003 · Cited by 5
Kapelios, C. J., & Lund, L. H. (2024) · Circulation · doi:10.1161/circulationaha.123.068066 · Cited by 5
Milhem, F. S., Almur, O., Hajjeh, O., Bdair, M., Dahmas, A. M., Haddad, K. B., Shubietah, A. R. M., Al-Said, O. S., Al-Braik, R., Abukhalil, M. M., et al. (2025) · Annals of Medicine and Surgery · doi:10.1097/ms9.0000000000003592 · Cited by 6
“These agents are being closely studied for their safety and efficacy in reducing adverse outcomes in AHF [ 203 , 204 ] .”
Savage, H. O., Dungu, J. N., Dimarco, A. D., Li, B., Langley, S., Amoah, J. K., Cliffe, P., Ganapathy, A., Watters, P., Campbell, P. C., et al. (2025) · ESC Heart Failure · doi:10.1002/ehf2.15407 · Cited by 4
Turgeon, R. D., Van, M. T., Loewen, P. S., Sadatsafavi, M., Zhang, W., MacDonald, B. J., MacKay, K., & Hawkins, N. M. (2025) · Journal of the American Heart Association · doi:10.1161/jaha.125.042943 · Cited by 4
Esteban, M., Maurou, O., Harboun, M., Nisse-Durgeat, S., & Esser, R. (2025) · Annales de Cardiologie et d Angéiologie · doi:10.1016/j.ancard.2025.101933 · Cited by 4
Evolving Decongestion Strategies in the Management of Acute Heart Failure
George, J., & Tang, W. H. W. (2025) · Current Treatment Options in Cardiovascular Medicine · doi:10.1007/s11936-025-01125-y · Cited by 4
“The ultimate demonstration of the benefits of in-hospital GDMT initiation and uptitration came from the STRONG-HF study, which demonstrated that a high-intensity care strategy involving rapid up-titration of GDMT was asso - ciated with improved survival and reduced hospital read-missions [66].”
InfluentialSvanström, H., Mkoma, G., Hviid, A., & Pasternak, B. (2025) · The Lancet Regional Health - Europe · doi:10.1016/j.lanepe.2025.101510 · Cited by 3
“12,13 Consistent with recent evidence and discussions surrounding optimal initiation and sequencing, 14–18 this strategy highlights the potential to maximize early therapeutic benefits.”
Novel angiotensin receptor target as therapy for the diabetic heart: the AT2R
Li, M., Wang, Y., & Widdop, R. E. (2025) · Journal of Molecular and Cellular Cardiology · doi:10.1016/j.yjmcc.2025.11.003 · Cited by 4
Bukanova-Berend, D., Campbell-James, T. A., & Vogel, J. (2025) · BMC Health Services Research · doi:10.1186/s12913-025-13687-5 · Cited by 4
The Role of GDF-15 in Heart Failure and Biomarker Potential—From Basic Science to Clinical Praxis
Barbosa, M., Martins, M. A., Fernandes-Silva, J., Melício, A., & Martins, Á. M. (2026) · Biology · doi:10.3390/biology15060516 · Cited by 4
Keshvani, N., Rizvi, S. K., Jain, A. K., Bustillo-Rubio, M., Segar, M. W., Coellar, J. D., Miller, J. W., Wang, T. J., Peterson, E. D., & Pandey, A. (2026) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2026.02.5113 · Cited by 4
Han, G., Eryılmaz, M., Goncharov, A., Li, Y., Ye, S., Tomoeda, A., Ngo, E., Scussat, M., Wang, X. Q., Ji, Z., et al. (2026) · Light Science & Applications · doi:10.1038/s41377-026-02275-9 · Cited by 4
“In particular, patients recently hospitalized for acute HF require frequent clinic visits (e.g., four visits within the fi rst two months) for titration of guideline-directed medical therapy guided by NT-proBNP levels 27 .”
Risk-Based Nurse-Managed Personalized Heart Failure Interventions
Butler, J., Kahwash, R., Khan, M. S., Zhang, D., Dukes, J. W., Reddy, M., Basuray, A., Gharib, E. G., Gerritse, B., Laechelt, A., et al. (2026) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2026.03.075 · Cited by 4
Lewsey, S. C., Martyn, T., Blumer, V. L., Brownell, N. K., Denfeld, Q. E., Dunlay, S. M., Goyal, P., Halloway, S., Matlock, D., Vardeny, O., et al. (2026) · Circulation · doi:10.1161/cir.0000000000001437 · Cited by 5
Nakao, Y. M., Nadarajah, R., Shuweihdi, F., Nakao, K., Fuat, A., Moore, J., Bates, C. J., Wu, J., & Gale, C. P. (2024) · BMJ Open · doi:10.1136/bmjopen-2023-073455 · Cited by 5
Weir, M. R., Rossignol, P., Pitt, B., Lund, L. H., Coats, A. J. S., Filippatos, G., Perrin, A., Waechter, S., Budden, J. J., Kosiborod, M., et al. (2024) · American Journal of Nephrology · doi:10.1159/000540453 · Cited by 4
“…acute HF showed that high-intensity care of rapidly up-titrating guideline-directed medical therapy, including ≥ 50% of maximum MRA dose, within 2 weeks of discharge followed by close monitoring improved outcomes, including risk of all-cause death and HF read-mission, compared with usual care [21].”
Self-citationDevoldere, J., Droogmans, S., Heggermont, W., & Craenenbroeck, E. M. V. (2024) · Acta cardiologica. Supplementum · doi:10.1080/00015385.2024.2396767 · Cited by 4
“Notably, the study was remarkable in that it achieved full up-titration to 100% of the recommended GDMT doses within just two weeks of patient discharge, under-scoring the feasibility and safety of rapid up-titration in acute care setting [33].”
Metadata
- Authors
- Mebazaa, A., Davison, B., Chioncel, O., Cohen-Solal, A., Diaz, R., Filippatos, G., Metra, M., Ponikowski, P., Sliwa, K., Voors, A. A., Edwards, C., Novosadova, M., Takagi, K., Damasceno, A., Saidu, H., Gayat, E., Pang, P. S., Celutkiene, J., & Cotter, G.
- Affiliations
- Inserm (FR)
- Carol Davila University of Medicine and Pharmacy (RO)
- National and Kapodistrian University of Athens (GR)
- Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia (IT)
- Wroclaw Medical University (PL)
- University of Cape Town (ZA)
- University Medical Center Groningen (NL)
- Momentum Research (US)
- Eduardo Mondlane University (MZ)
- Bayero University Kano (NG)
- Indiana University Indianapolis (US)
- Corresponding author
- Mebazaa, Alexandre
- ORCID
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2022-12
- Volume
- 400
- Issue
- 10367
- Pages
- 1938-1952
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W4308471536
- Cited by
- 1,123
- References
- 32
- Citations by year
- 2026: 293 · 2025: 311 · 2024: 289 · 2023: 223 · 2022: 6
- FWCI
- 144.33
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.elsevier.com/tdm/userlicense/1.0/ (tdm)
- www.elsevier.com/legal/tdmrep-license (tdm)
- www.elsevier.com/open-access/userlicense/1.0/ (am, 182 d)
- doi.org/10.15223/policy-017 (stm-asf)
- doi.org/10.15223/policy-037 (stm-asf)
- doi.org/10.15223/policy-012 (stm-asf)
- doi.org/10.15223/policy-029 (stm-asf)
- doi.org/10.15223/policy-004 (stm-asf)
- Locations
- The Lancet (acceptedVersion)
- PubMed (publishedVersion)
- IUScholarWorks (Indiana University) (submittedVersion)
- HAL (submittedVersion)
- Institutional Research Information System (Università degli Studi di Brescia) (submittedVersion)
- Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
- Funders
- Roche Diagnostics Corp
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart rate and cardiovascular health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Keywords
- acute heart failure, guideline-directed medical therapy, high-intensity care, heart failure readmission, all-cause mortality, NT-proBNP, left ventricular ejection fraction, outpatient monitoring, hospital discharge, drug safety and tolerability, heart failure pharmacotherapy
- MeSH terms
- Mineralocorticoid Receptor Antagonists, Female, Heart Failure, Humans, Male, Middle Aged, Quality of Life, Stroke Volume, Ventricular Function, Left, Treatment Outcome
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