%0 Randomized Controlled Trial
%T Early changes in renal function during rapid up-titration of guideline-directed medical therapy following an admission for acute heart failure.
%A Ter Maaten JM
%A Mebazaa A
%A Davison B
%A Edwards C
%A Adamo M
%A Arrigo M
%A Barros M
%A Biegus J
%A Čelutkienė J
%A Čerlinskaitė-Bajorė K
%A Chioncel O
%A Cohen-Solal A
%A Damasceno A
%A Diaz R
%A Filippatos G
%A Gayat E
%A Kimmoun A
%A Lam CSP
%A Leopold V
%A Novosadova M
%A Pagnesi M
%A Pang PS
%A Ponikowski P
%A Saidu H
%A Sliwa K
%A Takagi K
%A Tomasoni D
%A Metra M
%A Cotter G
%A Voors AA
%J Eur J Heart Fail
%V 25
%N 12
%D 2023 Dec 31
%M 37905361
%F 17.349
%R 10.1002/ejhf.3074
%X <B>OBJECTIVE: </B>In this subgroup analysis of STRONG-HF, we explored the association between changes in renal function and efficacy of rapid up-titration of guideline-directed medical therapy (GDMT) according to a high-intensity care (HIC) strategy.<BR><B>RESULTS: </B>In patients randomized to the HIC arm (n = 542), renal function was assessed at baseline and during follow-up visits. We studied the association with clinical characteristics and outcomes of a decrease in estimated glomerular filtration rate (eGFR) at week 1, defined as ≥15% decrease from baseline. Patients in the usual care group (n = 536) were seen at day 90. The treatment effect of HIC versus usual care was independent of baseline eGFR (p-interaction = 0.4809). A decrease in eGFR within 1 week occurred in 77 (15.5%) patients and was associated with more rales on examination (p = 0.004), and a higher New York Heart Association class at the corresponding visit. Following the decrease in eGFR at 1 week, lower average optimal doses of GDMT were prescribed during follow-up (p = 0.0210) and smaller reductions in N-terminal pro-B-type natriuretic peptide occurred (geometrical mean 0.81 in no eGFR decrease vs 1.12 in GFR decrease, p = 0.0003). The rate of heart failure (HF) readmission or death at 180 days was 12.3% in no eGFR decrease versus 18.5% in eGFR decrease (p = 0.2274) and HF readmissions were 7.8% versus 16.6% (p = 0.0496).<BR><B>CONCLUSIONS: </B>In the STRONG-HF study, HIC reduced 180-day HF readmission or death regardless of baseline eGFR. An early decrease in eGFR during rapid up-titration of GDMT was associated with more evidence of congestion, yet lower doses of GDMT during follow-up.