Intensive monitoring and rapid titration of heart failure therapy after hospitalization for heart failure rapidly improves the prognosis.

In this study, patients hospitalized for heart failure were assigned before discharge to either high-intensity care or usual care.

Patients in the high intensity care group were intensively monitored and treated according to a fixed protocol:

• Uptitration to at least 50% of the recommended target doses of heart failure drugs.
• Frequent follow-up at the consultation after 1, 2, 3 and 6 weeks for clinical check-up and blood sampling (renal function, ionogram, NT-proBNP).
• Titration of heart failure drugs according to the following criteria:
• ACE inhibitor/ARB or ARNI and /or MRA uptitration if blood pressure was ≥ 95 mmHg , potassium ≤ 5.0 mmol /l and creatinine clearance, GFR ≥ 30 ml/min.
• Uptitration of the beta-blocker if heart rate ≥ 55 per minute and blood pressure ≥ 95 mmHg were, unless NT-proBNP increased. In that case, diuretics were increased earlier.
• Discontinuation of diuretics in increasing renal impairment with a GFR < 30 ml/min, if there were no signs of fluid retention.

Results:

After 90 days, significantly more patients in the high intensity care group reached the recommended target dose of heart failure drugs (see table). This resulted in significantly lower blood pressure, lower NYHA class, better quality of life and lower NT-proBNP.

At 180 days, there was a significant reduction in the primary endpoint (hospitalizations for heart failure or all-cause mortality). This endpoint occurred in 15.2% of patients in the intensive care group versus 23.3% in the usual care group (relative risk reduction of 44%, number needed to treat (NNT): 12, p = 0.0021). There was mainly a reduction in new hospitalizations for heart failure, but also a slight reduction in mortality.