- Question
- After a hospital admission for acute heart failure, is rapid up-titration of guideline-directed therapies to full doses with close outpatient follow-up safe and effective compared with usual care?
- Design
- Multinational, open-label, randomised (1:1), parallel-group trial with 1078 patients randomly assigned (intention-to-treat population) at 87 hospitals in 14 countries, stratified by left ventricular ejection fraction (≤40% vs >40%) and country. The study was stopped early on the recommendation of the data and safety monitoring board.
- Population
- Patients aged 18-85 years admitted for acute heart failure who were not receiving full doses of guideline-directed drug therapy; mean age was 63.0 years and 39% were women.
- Intervention
- High-intensity care: up-titration of treatments to 100% of recommended doses within 2 weeks of discharge, with four scheduled outpatient visits over the following 2 months closely monitoring clinical status, laboratory values and NT-proBNP concentrations.
- Control
- Usual care, following local practice.
- Primary outcome
- Composite of heart failure readmission or all-cause death at 180 days.
- Results
- The primary endpoint occurred in 74 patients (15.2%, down-weighted adjusted Kaplan-Meier estimate) in the high-intensity care group and 109 (23.3%) in the usual care group (risk ratio 0.66; 95% CI 0.50-0.86; p=0.0021; adjusted risk difference 8.1%; 95% CI 2.9-13.2). By day 90, a higher proportion of the high-intensity group reached full doses of renin-angiotensin blockers (55% vs 2%), beta blockers (49% vs 4%) and mineralocorticoid receptor antagonists (84% vs 46%).
- Safety
- More adverse events occurred by 90 days with high-intensity care (41% vs 29%), with similar incidences of serious adverse events (16% vs 17%) and fatal adverse events (5% vs 6%).
- Conclusion
- An intensive strategy of rapid up-titration of guideline-directed therapy and close follow-up after an acute heart failure admission reduced the risk of all-cause death or heart failure readmission at 180 days compared with usual care.
- Why it matters
- It provided evidence that rapidly optimizing guideline-directed medical therapy after discharge, with frequent visits and biomarker monitoring, is feasible and beneficial, and strengthened the intensive follow-up model in the vulnerable post-discharge period.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 7, 2026