Name: STRONG-HF Results
Uploaded: 2026-03-06T09:42:26.000Z
Duration: 16 min 58 s
Description: Thousands of YouTube videos with English-Chinese subtitles! Now you can learn to understand native speakers, expand your vocabulary, and improve your pronunciation...

Well, I'm delighted to be joined here today by Dr. Alexandre Mabazza, who joins us from Paris, France.

My name is Amanda Vest from Tufts and in Boston.

Adverbs of manner

And we've just heard the presentation of the strong HF study, which was really exciting and potentially very practice changing for us all.

Would you like to tell us a little bit about why you did this study?

In fact, when we did this study originally, I was really, I hate acute heart failure.

But really seeing those patients coming and doing this big decompensation with a low oxygen saturation, their family are scared just because the therapy is not well done or implementation is not well done.

And I thought really we need to do something.

And you know, the literature is full of papers saying that really we are not doing so well.

And maybe because I am intensivist, I felt we should not be so scared about the safety issue of beta blocker and ace.

And the image I also got is that oncologist, when you go to see an oncologist and he discover cancer, he never say, okay, we give you a quarter of the dose in three months and a half and one year.

They say, come Wednesday, we give you a full dose and we give you a small card.

And if there is infection or fever or whatever, you call us.

And then I thought for heart failure we should do the same.

We give a full dose and then we check whether there is a safety issue and we handle the safety issue.

And for those who haven't seen the study so far, you should know that it builds on some prior data regarding the importance of up titration of medications early, either during or shortly after a heart failure hospitalization.

We have some data, for example, for spironolactone and the Arnie medications there.

And also builds in this frequent contact with a clinician.

And we're delighted to see that this does improve outcomes for patients.

So can you tell us a little bit more about your protocol?

Yeah, the protocol combines the two, which is, as you said, frequent visits and optimization.

And I think what we did is sometimes the visits could be just shaking hands because we are busy.

Then we say, okay, bye, bye, we hope to see you in three months.

And in fact here we put like a true procedure and we said to the cardiologist, you should follow the procedure.

The patient comes, goes to the to the lab to have a few exams Anti Probnp, potassium, creatinine and hemoglobin.

He comes with the results, enters for the visits and then the investigator were looking on the clinical exam, whether there is edema or not, blood pressure, heart rate, as simple as that.

And by combining everything he was, he was giving a green light to increase the doses of the drugs.

Then before in the high intensity arm, before being discharged, he receives half beta blocker and half ACE or RICE inhibitor and half spironolactone.

And then week one safety, exactly what they just described.

And week two is the crucial point is he check all the green light.

If there is no red light, he increased 200% with no discussion.

And then week three we check that the 100% worked well and then we see again the patient at week six and 90 days.

And in fact, apparently the people liked and the cardiologist felt secure to see this procedure.

And we told them if you have one signs which is red, no worries, you just ask that you don't change anything.

You just ask the patient to come one week, week later.

And often after one week that red light turns to green light because congestion left, because they add diuretics, because potassium is back to normal levels.

And then they will increase 200% of the three drugs.

So how often were patients seen on average in the intensive arm versus the usual care?

Then patients where we were writing a report and they were followed by cardiologists in town.

And for us they had an average one visit done by the investigators.

And the other arm they had an average of five visits.

That means that really people follow the protocol and the protocol, the protocol was really helpful because we had the three visits, the three weekly visit just after discharge and then six weeks and 90 days.

And can you summarise what your findings were between those two groups?

First, I mean, did it work for implementation?

If you combine the full optimal dose of beta blocker and RAS inhibitor and spironolactone.

If you combine full dose and minimum of half dose, we have more than 80%, 8,0% of the patients who had half to full of the three classes of drug.

And we know that the patients got those drugs because when you look on heart rate, it was decreased, blood pressure was decreased, potential potassium was a little bit increased and creatinine was stable.

And one of the first surprises is to look on the signs of congestion.

This is still not the primary endpoint but all the parameters of congestion were improved within three months, showing that again diuretics is classically a decongestive therapy, but

if you give a full therapy, full oral therapy, already we are resolving many of the congestion issues.

Then again all the congestion signs, I mean at least we are markedly reduced on 90 days.

And the primary endpoint was 180 days heart failure, readmission and death.

And that was markedly improved in the high intensity care arm with much less events in that arm compared to the usual care arm.

And the other parameter that we feel it's really very important is quality of life.

You know, you ask the patient how they feel and quality of life was much more improved.

And really patient basically liked so much being on the high intensity care arm.

And here again you hear many people saying but they don't like to be on the full dose of beta blocker, ACE, etc.

And in fact people felt that they're really doing better than before.

Concerning the other secondary endpoint, and

this is mortality, only mortality, 180 days, it was not statistically significant, but

there was a trend toward a better survival rate and the high intensity care.

And I think these results are very much welcomed by the cardiology community because they prove something that we thought might be the case.

We had some studies suggesting to us that the benefits of optimising GDMT can be really quite quick in terms of reducing heart failure re hospitalizations and also mortality.

And some weaker data showing that an early follow up after discharge is beneficial.

Of course that was included as an ideal a contact with the patient within seven days of discharge in the 2022 Heart Failure Guidelines.

So it's really nice to see them brought together in a randomized controlled trial and give us this very encouraging endpoint which I think will be quite practice changing.

Really helpful to both explain to our patients and payers and healthcare systems that this is important and works.

And if I may ask you, I was surprised to see that you'd recruited patients across the ejection fraction spectrum with a cut point at 40% on the subgroup analysis for ejection fraction.

And those patients with an ejection fraction over 40% were still seeing similar benefits with really no gradation of effect across the ejection fraction spectrum, which was sometimes seen for medications in the heart failure world.

Is it okay to be up titrating these medicines as briskly, including beta blockers in the HFPEF population or.

Or is the effect mainly in the heart failure with mildly reduced strata First I'm going to tell you a story.

It's funny because there are a few countries where the ethics committee rejected the protocol because they said there is no recommendation to give beta blocker to, to have this.

But in fact the reason why we put acute HFPF is because it's known today that health of the patients coming to any emergency room in the world.

Half of those patients have a preserved ejection fraction.

Then I felt that there is no way we will exclude them from, from, from this trial.

The other idea I had also is that many of those patients with acute hfpf, they have hypertension, they have coronary disease and those patients may benefit from that.

And the third thing is many of the data we published, it's a retrospective analysis.

But when we looked on the association between discharge medication and acute HFP consistently saw positive results and really combining all together, we felt that we should really put those patients.

And as you said, the results is surprisingly really.

Because when you do retrospective analysis, you know, you don't necessarily see the same for a prospective trial.

And the results is that they are doing as well as patients with a reduced ejection fraction.

And what are your takes on the adverse effects of this rapid up titration in the vulnerable post discharge transition period?

Yeah, I think you are, you're asking a very good question because again, the main reason why cardiologists, physicians all around the world are not uptight treating those drugs, mostly ACE per, indolactone and RAS inhibitors, Paranalactone and beta blockers, because they are scared of the side effect.

And in fact we really showed that people should be relaxed.

And these are a few tricks, as I told you, some red and green line to pay attention on.