Cardiology · General Practice · 3 h ago
STRONG-HF analysis links target GDMT doses to lower loop diuretic requirements
A post-hoc STRONG-HF analysis included 1,075 patients with post-randomization loop diuretic data. Achieving target doses of three guideline-directed therapy classes was associated with lower diuretic requirements at 90 days; high-intensity care benefits were consistent across diuretic dose groups.
- Analysis included 1,075 STRONG-HF participants with post-randomization diuretic data.
- Target GDMT doses were associated with greater diuretic dose reductions.
- High-intensity care benefit was consistent across diuretic dose groups.
- Post-hoc associations do not establish a causal diuretic-sparing effect.
A post-hoc analysis of STRONG-HF examined whether optimization of guideline-directed medical therapy (GDMT) was associated with lower loop diuretic requirements and whether diuretic dose predicted outcomes or modified treatment benefit. The analysis included 1,075 patients with post-randomization diuretic data, grouped by furosemide-equivalent dose. Investigators assessed dose changes at 90 days and all-cause death or heart failure rehospitalization at 180 days.
Patients reaching 100% of target doses of renin–angiotensin system inhibitors, beta-blockers and mineralocorticoid receptor antagonists had a mean diuretic dose reduction of 21.94 mg, compared with 1.55 mg among those not reaching targets (p<0.001). Higher diuretic doses reflected more severe heart failure, but dose category was not independently associated with the primary endpoint or its components. Diuretic dose doubling was associated with higher all-cause mortality (adjusted hazard ratio 1.47, 95% CI 1.04–2.09), but not with the primary endpoint or rehospitalization.
The benefit of high-intensity care was consistent across diuretic dose groups, with no treatment-by-dose interaction. These findings support an association between GDMT optimization and reduced diuretic requirements, but the post-hoc comparisons do not establish causality. Only the abstract was available for review, limiting assessment of adjustment methods and other potential sources of bias.
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European Journal of Heart Failure: GDMT is Associated with Reduced Loop Diuretic Requirements, Whereas Diuretic Dose Does Not Modify GDMT Benefit in Heart Failure: STRONG-HF. ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.