Supplementary Material for: Eligibility for rapid up-titration of guideline-directed medical therapy of real-world patients hospitalised for heart failure

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 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 in- and exclusion criteria of the STRONG-HF trial (systolic blood pressure [SBP]≥100mmHg, heart rate [HR]≥60min-1, serum potassium≤5mmol/L, eGFR≥30mL/min/1.73m2, discharge NT-proBNP>1500pg/mL) was assessed in a consecutive patient cohort at a tertiary referral center between 01/04/2021 and 31/12/2023.

Results: Data from 408 consecutive patients were analysed (male: 71%; age: 62[51-72]years; left ventricular ejection fraction: 27[20-35]%; HFrEF: 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.