Evaluating Eligibility Criteria Of The Strong-hf Trial For Patients In Real-world Setting, An Experience From An Advanced Heart Failure Program In A Tertiary Care Health System

Hua Ling, Ugochukwu Egolum

Research output: Contribution to conferencePosterpeer-review


The STRONG-HF trial has demonstrated that an intensive treatment strategy involving the rapid up-titration of guideline-directed medication therapy (GDMT) and close patient monitoring can significantly reduce the incidence of all-cause death or readmission for acute heart failure (AHF) within 180 days compared to standard care. Nonetheless, there are concerns regarding the trial's selection criteria potentially restricting the external validity of this study, which may result in only a smaller group of patients being eligible for this novel intensive treatment strategy.

We hypothesize that a substantial number of patients admitted with AHF at Northeast Georgia Medical Center are not eligible for rapid up-titration of GDMT according to the inclusion and exclusion criteria of the STRONG-HF trial.

We retrospectively reviewed the medical records of patients with AHF who were admitted from January 1 to January 31, 2022, and assessed their eligibility for the STRONG-HF trial. Hospitalizations primarily due to AHF were identified using diagnosis-related group codes 291, 292, and 293.

In January 2022, a total of 94 patients with AHF were hospitalized. Among them, nine were not followed by cardiologists at our center and thus excluded from the analysis. A retrospective review of the remaining 85 patients revealed that only six patients (7.1%) met the inclusion and exclusion criteria for rapid up-titration of GDMT, and one of these patients died within three months of discharge. On day 80-100, out of five patients, only one took sacubitril/valsartan, and two took Sodium-glucose Cotransporter-2 inhibitors (dapagliflozin 10 mg). Of the remaining 79 patients (92.9%), the top reasons for not meeting the criteria were eGFR <30 mL/min/1·73m² or dialysis within three months after admission, NT-proBNP <2500 pg/mL at admission, age <18 or >85 years, and had active infection at any time during the AHF hospitalization.

The present findings suggest that a considerable proportion of patients admitted to our medical center with AHF may not meet the inclusion and exclusion criteria for the rapid up-titration of GDMT as per the STRONG-HF trial. It is unclear whether the potential benefits of this intensive treatment strategy could be extended to our patients in real-world settings. Further studies are needed to evaluate the feasibility and effectiveness of implementing the rapid up-titration approach in broader patient populations.
Original languageEnglish
StatePublished - Jan 1 2024

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