Don't Miss a Beat: STRONG-HF with Alexandre Mebazaa, MD, PhD


Don't Miss a Beat hosts are joined by Alexandre Mebazaa, MD, PhD, lead investigator of the STRONG-HF trial, to discuss the inspiration for the trial, its design, and important takeaways for those looking to implement a similar strategy of rapid, in-hospital uptitration of GDMT in heart failure at their own practice.

Episode Highlight Timestamps

0:35 - Episode Overview

3:00 - Introduction of Alexandre Mebazaa, MD, PhD

3:20 - Origins of STRONG-HF Design

10:50 - Study Population

19:05 - Safety Data from STRONG-HF

23:40 - Implementing STRONG-HF in Real-World

STRONG-HF represents one of the most innovative and impactful trials in cardiology in the last decade. A landmark trial in both its design and results, results of the study provided the first proof from a randomized clinical trial that in-hospital initiation and rapid uptitration of guideline-directed medical therapy in heart failure was associated with a statistically significant reduction in risk of 180-day all-cause mortality and heart failure readmission.

Presented at the American Heart Association (AHA) 2022 Scientific Sessions by Alexandre Mebazaa, MD, PhD, of the University of Paris, the investigator-initiated trial enrolled patients from more than a dozen countries and randomized them to rapid, uptitration of renin-angiotensin blockers, β-blockers, and mineralocorticoid receptor antagonists. Of note, SGLT2 inhibitors were not considered to be a part of GDMT for heart failure when the trial was launched in 2018.

Designed to enroll 1800 patients, the trial was stopped early by the Data Safety and Monitoring Board Data Safety Monitoring Board based on superior efficacy observed in the GDMT arm of the trial. At AHA 2022, Mebazaa provided insight into the results among the 1078 individuals successfully randomized in the study. Using data recorded before the October 18, 2022 data cutoff, results indicated heart failure readmission or all-cause death up to day 180 occurred in 74 (15.2% down-weighted adjusted Kaplan-Meier estimate) of patients randomized to the high-intensity care group and 109 (23.3%) patients in the usual care group (adjusted risk difference, 8.1% [95% CI 2.9-13.2] P=.0021; risk ratio, 0.66 [95% CI 0.50-0.86]). With safety data further supporting this high-intensity care strategy, the immediate focus shifted, as Mebazaa mentioned during his presentation, to education and implementation of STRONG-HF procedure into clinical practice.

With an interest in taking a deeper dive into the trial and what results mean for practicing clinicians treating patients with heart failure, the hosts of Don’t Miss a Beat, Stephen Greene, MD, of Duke University School of Medicine, and Muthiah Vaduganathan, MD, MPH, of Brigham and Women’s Hospital, invited Mebazaa to be a special guest on their first episode of 2023.

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