Tiredness, shortness of breath, cough, swelling: these are all symptoms connected to heart failure, a condition that affects around 600,000 people in Italy alone and is the leading cause of hospitalization for the over 65s. When it is present, the heart is no longer capable of doing its job well: pumping blood to oxygenate the tissues. A condition that can manifest itself and worsen over time or appear suddenly, in acute forms. Forms that can be managed more successfully thanks to close monitoring and rapid adaptation of therapy, up to the levels recommended by the guidelines. Compared to the standard of care, in fact, a “high intensity” treatment for patients with acute heart failure manages to reduce hospitalizations and deaths. This is what emerges from the STRONG-HF study whose results have just been published in the Lancet.
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by Simone Valesini
The unanswered questions
Acute heart failure is most often a worsening of the chronic condition of the disease, and patients hospitalized for acute heart failure are at high risk of rehospitalization and death, especially in the first months after discharge. The management of these patients is not simple: doctors are cautious about increasing therapeutic dosages, due to the limited data available relating to the therapeutic approach, such as drugs to be prescribed, in which doses and at what time and on the basis of which monitoring . It is precisely from here that the work of the researchers started: to seek evidence to guide clinical practice.
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I study
Thus, to understand if it was possible to improve this treatment strategy, the STRONG-HF study compared the standard of care to a so-called high-intensity treatment. When we speak of “high intensity of care”, in this case, we are referring to a treatment regimen involving close monitoring, in which laboratory tests were used alongside frequent visits, including the Elecsys NT-proBNP test ( n-terminal fragment of BNP, brain natriuretic peptide), a test that aids in the differential diagnosis of heart failure and in patient risk stratification. This close monitoring was used to control escalation of therapy. Overall, a thousand people were involved in the study.
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The results
The data show that, under close monitoring, it is possible to increase the therapies up to the dosages recommended by the guidelines. In fact, in the “high intensity” arm, after six months the absolute risk (8.1%) and the relative risk (34%) of all-cause mortality or re-hospitalization for heart failure decreased compared with the current standard of care. In closely monitored patients, the risk of mortality or re-hospitalization was 15% compared with 23% in the standard treatment arm. The quality of life of patients in the experimental arm was also better. This, in the face of an increased risk of adverse events, but not serious, and probably partly attributable to more intense monitoring. In fact, in view of the results, the study was stopped early due to the superior benefits observed in the experimental arm.