Eligibility for Rapid Up-Titration of Guideline-Directed Medical Therapy of Real-World Patients Hospitalised for Heart Failure

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Introduction and Aims: The 2023 Focused Update of the 2021 ESC Heart Failure (HF) Guidelines recommends the rapid up-titration (RT) of guideline-directed medical therapy (GDMT) for all patients hospitalised for HF to improve prognosis in light of the STRONG-HF trial. However, the real-world feasibility of RT and the optimal selection of suitable patients may cause difficulties as the STRONG-HF trial applied strict randomisation criteria. We aimed to assess the proportion of hospitalised HF patients suitable for RT after discharge. Methods: The proportion of patients eligible for RT based on the basic inclusion and exclusion criteria of the STRONG-HF trial (systolic blood pressure [SBP] ≥100 mm Hg, heart rate [HR] ≥60 min−1, serum potassium ≤5 mmol/L, estimated glomerular filtration rate [eGFR] ≥30 mL/min/1.73 m2, discharge N-terminal pro-B type natriuretic peptide [NT-proBNP] >1,500 pg/mL) was assessed in a consecutive patient cohort at a tertiary referral centre between April 01, 2021, and December 31, 2023. Results: Data from 408 consecutive patients were analysed (male: 71%; age: 62 [51–72] years; left ventricular ejection fraction: 27 [20–35]%; HF with reduced ejection fraction: 82%; hypertension: 67%; diabetes: 36%; atrial fibrillation: 47%). 78% of the patients were suitable for RT based on the SBP criterion, 93% on HR, 89% on serum potassium, and 91% on eGFR values. Thus, 60% were eligible for RT using the combined assessment of these parameters. When including the NT-proBNP value as well (60%), 34% of the cohort were eligible for RT. Conclusions: Based on our study, the proportion of patients suitable for RT of GDMT ranged from 34% to 60% based on the basic eligibility indicators of the STRONG-HF trial. Our results highlight the strategic importance of careful selection of patients eligible for RT.