Safety, Tolerability and Efficacy of Rapid Optimization, Helped by NT-proBNP testinG, of Heart Failure Therapies
STRONG-HF
1 other identifier
interventional
1,800
12 countries
78
Brief Summary
STRONG-HF is a multicenter, randomized, parallel group study designed to evaluate the efficacy and safety of up-titration of standard oral heart failure medications during hospitalization for acute heart failure. Patients admitted for acute heart failure will be randomized within 2 days before discharge to either usual care or intensification of treatment with a beta-blocker, a renin-angiotensin system blocker, and a mineralocorticoid receptor blocker ("high intensity care" arm). In the "high intensity care" arm, patients' clinical signs and symptoms of heart failure will be assessed, and routine laboratory measures and biomarkers will be measured, at frequent post-discharge visits. When these measures indicate that it is safe to do so, the doses of the oral heart failure medications will be increased to optimal levels. Patients will be followed through 180 days from randomization. Patients assigned to the usual care group will be followed by their general physician and/or cardiologist according to local medical standards. Patients who were screened but did not meet eligibility criteria will be followed for 90-day outcome. Randomized patients will be contacted at 180 days to assess outcomes.
Trial Health
Trial Health Score
Automated assessment based on enrollment pace, timeline, and geographic reach
participants targeted
Target at P75+ for not_applicable heart-failure
Started May 2018
Typical duration for not_applicable heart-failure
78 active sites
Health score is calculated from publicly available data and should be used for screening purposes only.
Trial Relationships
Click on a node to explore related trials.
Study Timeline
Key milestones and dates
First Submitted
Initial submission to the registry
January 12, 2018
CompletedFirst Posted
Study publicly available on registry
January 26, 2018
CompletedStudy Start
First participant enrolled
May 11, 2018
CompletedPrimary Completion
Last participant's last visit for primary outcome
October 1, 2021
CompletedStudy Completion
Last participant's last visit for all outcomes
October 1, 2021
CompletedFebruary 12, 2021
February 1, 2021
3.4 years
January 12, 2018
February 9, 2021
Conditions
Keywords
Outcome Measures
Primary Outcomes (1)
180-day all-cause mortality or heart failure readmission
Cumulative risk of either readmission for heart failure or death at 180 days
180 days
Secondary Outcomes (3)
Change in quality of life
90 days
180-day all-cause mortality
180 days
90-day all-cause mortality or heart failure readmission
90 days
Other Outcomes (13)
180-day cardiovascular death
180 days
90-day cardiovascular death
90 days
90-day all-cause mortality
90 days
- +10 more other outcomes
Study Arms (2)
Usual Care
ACTIVE COMPARATORFollow-up and management of heart failure medications provided by the patient's general physician and/or cardiologist according to local medical standards
High Intensity Care
EXPERIMENTALFollow-up and management of heart failure medications provided by specialists at participating institutions. Doses of oral heart failure medications optimized within 2 weeks, provided clinical assessments and laboratory measures indicate that it is safe to increase doses.
Interventions
Follow-up and management of heart failure medications provided by the patient's general physician and/or cardiologist according to local medical standards
Follow-up and management of heart failure medications provided by specialists at participating institutions. Doses of oral heart failure medications optimized within 2 weeks, provided clinical assessments and laboratory measures indicate that it is safe to increase doses.
Eligibility Criteria
You may qualify if:
- Hospital admission within the 72 hours prior to Screening for acute heart failure with dyspnea at rest and pulmonary congestion on chest X-ray, and other signs and/or symptoms of heart failure such as edema and/or positive rales on auscultation.
- All measures within 24 hours prior to Randomization of systolic blood pressure ≥ 100 mmHg, and of heart rate ≥ 60 bpm.
- All measures within 24 hours prior to Randomization of serum potassium ≤ 5.0 mEq/L (mmol/L).
- Biomarker criteria for persistent congestion:
- At Screening, NT-proBNP \> 2,500 pg/mL.
- At the time of Randomization (within 2 days prior to discharge), NT-proBNP \> 1,500 pg/mL (to ensure the persistence of congestion) that has decreased by more than 10% compared to Screening (to ensure the acuity of the index episode).
- At 1 week prior to admission, at Screening, and at Visit 2 (just prior to Randomization) either (a) \<= ½ the optimal dose of ACEi/ARB/ARNi (see Table) prescribed, no beta-blocker prescribed, and \<= ½ the optimal dose of MRA prescribed or (b) no ACEi/ARB/ARNi prescribed, \<= ½ the optimal dose of beta-blocker prescribed, and \<= ½ the optimal dose of MRA prescribed.
- Written informed consent to participate in the study.
You may not qualify if:
- Age \< 18 or \> 85 years.
- Clearly documented intolerance to high doses of beta-blockers.
- Clearly documented intolerance to high doses of renin-angiotensin system (RAS) blockers (both ACEi and ARB).
- Mechanical ventilation \[not including continuous positive airway pressure (CPAP)/bilevel positive airway pressure (BIPAP)\] in the 24 hours prior to Screening.
- Significant pulmonary disease contributing substantially to the patients' dyspnea such as forced expiratory volume during the 1st second (FEV1)\< 1 liter or need for chronic systemic or nonsystemic steroid therapy, or any kind of primary right heart failure such as primary pulmonary hypertension or recurrent pulmonary embolism.
- Myocardial infarction, unstable angina or cardiac surgery within 3 months, or cardiac resynchronization therapy (CRT) device implantation within 3 months, or percutaneous transluminal coronary intervention (PTCI), within 1 month prior to Screening.
- Uncorrected thyroid disease, active myocarditis, or known amyloid or hypertrophic obstructive cardiomyopathy.
- History of heart transplant or on a transplant list, or using or planned to be implanted with a ventricular assist device.
- Sustained ventricular arrhythmia with syncopal episodes within the 3 months prior to screening that is untreated.
- Presence at Screening of any hemodynamically significant valvular stenosis or regurgitation, except mitral or tricuspid regurgitation secondary to left ventricular dilatation, or the presence of any hemodynamically significant obstructive lesion of the left ventricular outflow tract.
- Active infection at any time during the AHF hospitalization prior to Randomization based on abnormal temperature and elevated white blood cells (WBC) or need for intravenous antibiotics.
- Stroke or transient ischemic attack (TIA) within the 3 months prior to Screening.
- Primary liver disease considered to be life threatening.
- Renal disease or estimated glomerular filtration rate (eGFR) \< 30 mL/min/1.73m2 \[as estimated by the simplified Modification of Diet in Renal Disease (MDRD) formula\] at Screening or history of dialysis.
- Psychiatric or neurological disorder, cirrhosis, or active malignancy leading to a life expectancy \< 6 months.
- +4 more criteria
Contact the study team to confirm eligibility.
Sponsors & Collaborators
- Heart Initiativelead
- Hôpitaux Universitaires Saint-Louis-Lariboisièrecollaborator
- Momentum Research, Inc.collaborator
- Roche Diagnostics GmbHcollaborator
- INSERM UMR-942, Paris, Francecollaborator
Study Sites (78)
Sanatorio de la Canada
Villa María, Córdoba Province, X5900JKA, Argentina
Chutro Srl Clinic
Córdoba, Argentina
Del Prado Private Clinic
Córdoba, Argentina
San Roque Hospital
Córdoba, Argentina
Rosario Cardiovascular Institute
Rosario, Argentina
Rosario Clinical Research Institute - Delta
Rosario, Argentina
Modelo Cardiology Center
San Miguel de Tucumán, Argentina
Diagnostic and Treatment Medical Clinic SA
Santa Fe, Argentina
Santa Rosa Hospital
Santa Rosa, Argentina
San Martin SA Clinic
Venado Tuerto, Argentina
Fusavim Privada SRL Clinic
Villa María, Argentina
Internal Med. 1, St. Josef Hospital Braunau
Braunau am Inn, Austria
Clin. Dep. Internal Med 3, University Hospital St. Poelten
Sankt Pölten, Austria
1. Med. Dep, Donauspital
Vienna, Austria
Cardiology Department at Hietzing Hospital with Neurological Center Rosenhugel
Vienna, Austria
Dep. Of Cardiology, Medical Univ. Vienna
Vienna, Austria
Internal Med., LKH Villach
Villach, Austria
Cardiovascular Diagnostic Center
Cartagena, Departamento de Bolívar, 130001, Colombia
CEQUIN Cardiomet Foundation
Armenia, Quindío Department, 630004, Colombia
Cardiomet Pereira Clinical Research Center Foundation
Pereira, Risaralda Department, 660003, Colombia
Santander Ophthalmological Foundation
Bucaramanga, Santander Department, 681004, Colombia
Auxerre Hospital Center
Auxerre, France
University Hospital of Beziers
Béziers, France
Center Hospital Regional University of Tours Trousseu Hospital
Chambray-lès-Tours, France
University Hospital Henri Mondor
Creil, France
CHU Dijon Burgundy F. Mitterand
Dijon, France
Hôpitaux Universitaires Saint-Louis-Lariboisière, University Paris Diderot
Paris, France
Center Hospital of Toulon
Toulon, France
Buda Hospital of the Hospitaller Order of Saint John of God
Budapest, Hungary
Kanizsai Dorottya Hospital
Nagykanizsa, Hungary
St. Rafael Hospital in Zala County
Zalaegerszeg, Hungary
Barzilay MC Ashkelon
Ashkelon, Israel
Asaf Harofe MC
Ẕerifin, Israel
Dept of Medicine Research unit, Maputo Central Hospital
Maputo, Mozambique
Mavalane Hospital, National Institute of Health
Maputo, Mozambique
Amino Kano Teaching Hospital
Kano, Nigeria
Murtala Muhammad Specialist Hospital
Kano, Nigeria
State Budget HealthCare Institution "First City clinical hospital named after E.E. Volosevich"
Arkhangelsk, Russia
Regional budget Healthcare Institution "Cardiological dispensary"
Ivanovo, Russia
Federal State Budget Educational Institution of Higher Education "Moscow State Medico-Dental University n.a. A.I. Evdokimov", under Ministry of Health of the Russian Federation
Moscow, Russia
Federal State Budget Educational Institution of Higher Education "Moscow State University n.a. M.V. Lomonosov", independent division Medical research Educational Centre
Moscow, Russia
Moscow City Hospital # 81, Moscow
Moscow, Russia
Moscow State Budget Healthcare Institution City clinical Hospital 52 of Moscow Healthcare Department
Moscow, Russia
Primary Healthcare Unit of the RF Ministry of Internal Affairs in Moscow
Moscow, Russia
Russian National Research Medical University n.a. N.I.Pirogov based at City Clinical hospital n.a. V.M.Buyanov DZM
Moscow, Russia
SBHI of Moscow City clinical hospital 64 of Moscow Healthcare department
Moscow, Russia
State Budget HealthCare Institution of Moscow "City clinical hospital 15 n.a. O.M. Filatov under Department of HealthCare of Moscow"
Moscow, Russia
State Budget HealthCare Institution of Moscow "City clinical hospital 29 n.a. N.E. Bauman under Department of HealthCare of Moscow"
Moscow, Russia
State Budget HealthCare Institution of Mosocw "City clinical hospital 51 under Department of HealthCare of Moscow"
Moscow, Russia
Saint-Petersburg State Budget HealthCare Institution "City hospital 38 n.a. N.A. Semashko"
Pushkin, Russia
Municipal Government-financed Institution of Healthcare "City Emergency Hospital" of Rostov-on-Don City
Rostov-on-Don, Russia
Federal State Budgetary Educational Institution of Higher Education "Ryazan State Medical University named after academician I.P. Pavlov"
Ryazan, Russia
Federal State Budget Educational Institution of Higher Education "North-West state medical university n.a. I.I. Mechnikov under the Ministry of Health of the Russian Federation"
Saint Petersburg, Russia
Saint Petersburg State Budget Healthcare Institution Pokrovskaya City Hospital
Saint Petersburg, Russia
Saint-Petersburg State Budget Healthcare Institution City Hospital 15
Saint Petersburg, Russia
State Budget Institution "Saint Petersburg state budget research institution of first aid named after I. I. Dzhanelidze"
Saint Petersburg, Russia
State Budget HealthCare Institution of Vladimir Region "City Hospital 4 of Vladimir"
Vladimir, Russia
State Institution of Healthcare of Yaroslavl Region "Clinical Hospital 8"
Yaroslavl, Russia
National Institute of Cardio and Vascular Diseases
Bratislava, Slovakia
V. Internal Clinic, LFUK and UNB Bratislava
Bratislava, Slovakia
Internal Department, Hospital with Polyclinic Brezno
Brezno, Slovakia
Internal Department, Dolnooravian Hospital of Dr. L.N.Jege
Dolný Kubín, Slovakia
Internal Department, Hospital with Polyclinic Lucenec
Lučenec, Slovakia
First Internal Clinic, Faculty Hospital with Polyclinic Nove Zamky
Nové Zámky, Slovakia
Department of Internal Medicine Hospital Rimavska Sobota
Rimavská Sobota, Slovakia
Department of Internal Medicine UVN SNP-FN
Ružomberok, Slovakia
Internal Department, NsP Spisska Nova Ves
Spišská Nová Ves, Slovakia
Internal Department Hospital Arm General L. Svobodu Svidnik
Svidník, Slovakia
Groote Schuur Hospital
Cape Town, South Africa
Nelson Mandela Academic Hospital, Walter Sisulu University
Mthatha, South Africa
Habib Bougatfa Hospital
Bizerte, Tunisia
Regional Hospital of Jendouba
Jendouba, Tunisia
Fattouma Bourguiba Hospital
Monastir, Tunisia
Hedi chaker Hospital
Sfax, Tunisia
Charles Nicolle Hospital
Tunis, Tunisia
Habib Thameur Hospital
Tunis, Tunisia
La Rabta Hospital
Tunis, Tunisia
Military Hospital
Tunis, Tunisia
Related Publications (13)
Zhang X, Davison B, Adamo M, Arrigo M, Biegus J, Chioncel O, Cohen Solal A, Cotter G, Edwards C, Kimmoun A, Lam CSP, Mebazaa A, Metra M, Novosadova M, Pang PS, Sliwa K, Takagi K, Voors AA, Ezekowitz JA. Guideline-Directed Medical Therapy Use in the STRONG-HF Trial. Circ Heart Fail. 2025 Sep;18(9):e012716. doi: 10.1161/CIRCHEARTFAILURE.124.012716. Epub 2025 Jul 3.
PMID: 40605744DERIVEDMyhre PL, Grupper A, Mebazaa A, Davison B, Edwards C, Takagi K, Adamo M, Arrigo M, Barros M, Biegus J, Celutkiene J, Cerlinskaite-Bajore K, Chioncel O, Cohen-Solal A, Damasceno A, Deniau B, Diaz R, Filippatos G, Gayat E, Kimmoun A, Ter Maaten JM, Metra M, Novosadova M, Pagnesi M, Pang PS, Ponikowski P, Saidu H, Sliwa K, Tomasoni D, Voors A, Cotter G, Lam CSP. Changes in Liver Function Tests, Congestion, and Prognosis After Acute Heart Failure: The STRONG-HF Trial. JACC Adv. 2025 Mar;4(3):101607. doi: 10.1016/j.jacadv.2025.101607. Epub 2025 Feb 21.
PMID: 39983609DERIVEDFarmakis D, Davison B, Fountoulaki K, Liori S, Chioncel O, Metra M, Celutkiene J, Cohen-Solal A, Damasceno A, Diaz R, Edwards C, Gayat E, Novosadova M, Bistola V, Pang PS, Ponikowski P, Saidu H, Sliwa K, Takagi K, Voors AA, Mebazaa A, Cotter G, Filippatos G. Rapid Uptitration of Guideline-Directed Medical Therapies in Acute Heart Failure With and Without Atrial Fibrillation. JACC Heart Fail. 2024 Nov;12(11):1845-1858. doi: 10.1016/j.jchf.2024.06.010. Epub 2024 Aug 14.
PMID: 39152986DERIVEDArrigo M, Davison B, Edwards C, Adamo M, Ambrosy AP, Barros M, Biegus J, Celutkiene J, Cerlinskaite-Bajore K, Chioncel O, Cohen-Solal A, Damasceno A, Diaz R, Filippatos G, Gayat E, Kimmoun A, Lam CSP, Metra M, Novosadova M, Pagnesi M, Pang PS, Ponikowski P, Saidu H, Sliwa K, Takagi K, Ter Maaten JM, Tomasoni D, Voors AA, Cotter G, Mebazaa A. Characteristics, treatment, and outcomes of early vs. late enrollees of the STRONG-HF trial. Am Heart J. 2024 Aug;274:119-129. doi: 10.1016/j.ahj.2024.04.019. Epub 2024 May 12.
PMID: 38740532DERIVEDAmbrosy AP, Chang AJ, Davison B, Voors A, Cohen-Solal A, Damasceno A, Kimmoun A, Lam CSP, Edwards C, Tomasoni D, Gayat E, Filippatos G, Saidu H, Biegus J, Celutkiene J, Ter Maaten JM, Cerlinskaite-Bajore K, Sliwa K, Takagi K, Metra M, Novosadova M, Barros M, Adamo M, Pagnesi M, Arrigo M, Chioncel O, Diaz R, Pang PS, Ponikowski P, Cotter G, Mebazaa A. Titration of Medications After Acute Heart Failure Is Safe, Tolerated, and Effective Regardless of Risk. JACC Heart Fail. 2024 Sep;12(9):1566-1582. doi: 10.1016/j.jchf.2024.04.017. Epub 2024 May 12.
PMID: 38739123DERIVEDCelutkiene J, Cerlinskaite-Bajore K, Cotter G, Edwards C, Adamo M, Arrigo M, Barros M, Biegus J, Chioncel O, Cohen-Solal A, Damasceno A, Diaz R, Filippatos G, Gayat E, Kimmoun A, Leopold V, Metra M, Novosadova M, Pagnesi M, Pang PS, Ponikowski P, Saidu H, Sliwa K, Takagi K, Ter Maaten JM, Tomasoni D, Lam CSP, Voors AA, Mebazaa A, Davison B. Impact of Rapid Up-Titration of Guideline-Directed Medical Therapies on Quality of Life: Insights From the STRONG-HF Trial. Circ Heart Fail. 2024 Apr;17(4):e011221. doi: 10.1161/CIRCHEARTFAILURE.123.011221. Epub 2024 Mar 6.
PMID: 38445950DERIVEDCotter G, Deniau B, Davison B, Edwards C, Adamo M, Arrigo M, Barros M, Biegus J, Celutkiene J, Cerlinskaite-Bajore K, Chioncel O, Cohen-Solal A, Damasceno A, Diaz R, Filippatos G, Gayat E, Kimmoun A, Lam CSP, Metra M, Novosadova M, Pang PS, Pagnesi M, Ponikowski P, Saidu H, Sliwa K, Takagi K, Ter Maaten JM, Tomasoni D, Voors A, Mebazaa A. Optimization of Evidence-Based Heart Failure Medications After an Acute Heart Failure Admission: A Secondary Analysis of the STRONG-HF Randomized Clinical Trial. JAMA Cardiol. 2024 Feb 1;9(2):114-124. doi: 10.1001/jamacardio.2023.4553.
PMID: 38150260DERIVEDPagnesi M, Metra M, Cohen-Solal A, Edwards C, Adamo M, Tomasoni D, Lam CSP, Chioncel O, Diaz R, Filippatos G, Ponikowski P, Sliwa K, Voors AA, Kimmoun A, Novosadova M, Takagi K, Barros M, Damasceno A, Saidu H, Gayat E, Pang PS, Celutkiene J, Cotter G, Mebazaa A, Davison B. Uptitrating Treatment After Heart Failure Hospitalization Across the Spectrum of Left Ventricular Ejection Fraction. J Am Coll Cardiol. 2023 Jun 6;81(22):2131-2144. doi: 10.1016/j.jacc.2023.03.426.
PMID: 37257948DERIVEDAdamo M, Pagnesi M, Mebazaa A, Davison B, Edwards C, Tomasoni D, Arrigo M, Barros M, Biegus J, Celutkiene J, Cerlinskaite-Bajore K, Chioncel O, Cohen-Solal A, Damasceno A, Diaz R, Filippatos G, Gayat E, Kimmoun A, Lam CSP, Novosadova M, Pang PS, Ponikowski P, Saidu H, Sliwa K, Takagi K, Ter Maaten JM, Voors A, Cotter G, Metra M. NT-proBNP and high intensity care for acute heart failure: the STRONG-HF trial. Eur Heart J. 2023 Aug 14;44(31):2947-2962. doi: 10.1093/eurheartj/ehad335.
PMID: 37217188DERIVEDCerlinskaite-Bajore K, Lam CSP, Sliwa K, Adamo M, Ter Maaten JM, Leopold V, Mebazaa A, Davison B, Edwards C, Arrigo M, Barros M, Biegus J, Chioncel O, Cohen-Solal A, Damasceno A, Diaz R, Filippatos G, Gayat E, Kimmoun A, Metra M, Novosadova M, Pagnesi M, Pang PS, Ponikowski P, Saidu H, Takagi K, Tomasoni D, Voors AA, Cotter G, Celutkiene J. Sex-specific analysis of the rapid up-titration of guideline-directed medical therapies after a hospitalization for acute heart failure: Insights from the STRONG-HF trial. Eur J Heart Fail. 2023 Jul;25(7):1156-1165. doi: 10.1002/ejhf.2882. Epub 2023 Jun 1.
PMID: 37191154DERIVEDMebazaa A, Davison B, Chioncel O, Cohen-Solal A, Diaz R, Filippatos G, Metra M, Ponikowski P, Sliwa K, Voors AA, Edwards C, Novosadova M, Takagi K, Damasceno A, Saidu H, Gayat E, Pang PS, Celutkiene J, Cotter G. Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure (STRONG-HF): a multinational, open-label, randomised, trial. Lancet. 2022 Dec 3;400(10367):1938-1952. doi: 10.1016/S0140-6736(22)02076-1. Epub 2022 Nov 7.
PMID: 36356631DERIVEDCotter G, Davison B, Metra M, Sliwa K, Voors AA, Addad F, Celutkiene J, Chioncel O, Cohen Solal A, Diaz R, Damasceno A, Duengen HD, Filippatos G, Goncalvesova E, Merai I, Ponikowski P, Privalov D, Sani MU, Takagi K, Shogenov Z, Saidu H, Mebazaa A. Amended STRONG-HF study design. Eur J Heart Fail. 2021 Nov;23(11):1981-1982. doi: 10.1002/ejhf.2348. Epub 2021 Oct 4. No abstract available.
PMID: 34529313DERIVEDKimmoun A, Cotter G, Davison B, Takagi K, Addad F, Celutkiene J, Chioncel O, Solal AC, Diaz R, Damasceno A, Duengen HD, Filippatos G, Goncalvesova E, Merai I, Metra M, Ponikowski P, Privalov D, Sliwa K, Sani MU, Voors AA, Shogenov Z, Mebazaa A. Safety, Tolerability and efficacy of Rapid Optimization, helped by NT-proBNP and GDF-15, of Heart Failure therapies (STRONG-HF): rationale and design for a multicentre, randomized, parallel-group study. Eur J Heart Fail. 2019 Nov;21(11):1459-1467. doi: 10.1002/ejhf.1575. Epub 2019 Aug 19.
PMID: 31423712DERIVED
MeSH Terms
Conditions
Condition Hierarchy (Ancestors)
Study Officials
- PRINCIPAL INVESTIGATOR
Alexandre Mebazaa, MD PhD FESC
Inserm UMRS 942; Hôpitaux Universitaires Saint-Louis-Lariboisière, University Paris Diderot
Central Study Contacts
Study Design
- Study Type
- interventional
- Phase
- not applicable
- Allocation
- RANDOMIZED
- Masking
- NONE
- Purpose
- TREATMENT
- Intervention Model
- PARALLEL
- Sponsor Type
- OTHER
- Responsible Party
- SPONSOR
Study Record Dates
First Submitted
January 12, 2018
First Posted
January 26, 2018
Study Start
May 11, 2018
Primary Completion
October 1, 2021
Study Completion
October 1, 2021
Last Updated
February 12, 2021
Record last verified: 2021-02