BACKGROUND:This analysis provides details on baseline and changes in quality of life (QoL) and its components as measured by EQ-5D-5L questionnaire, as well as association with objective outcomes, applying high-intensity heart failure (HF) care in patients with acute HF.METHODS:In STRONG-HF trial (Safety, Tolerability, and Efficacy of Rapid Optimization, Helped by NT-proBNP Testing, of Heart Failure Therapies) patients with acute HF were randomized just before discharge to either usual care or a high-intensity care strategy of guideline-directed medical therapy up-titration. Patients ranked their state of health on the EQ-5D visual analog scale score ranging from 0 (the worst imaginable health) to 100 (the best imaginable health) at baseline and at 90 days follow-up.RESULTS:In 1072 patients with acute HF with available assessment of QoL (539/533 patients assigned high-intensity care/usual care) the mean baseline EQ-visual analog scale score was 59.2 (SD, 15.1) with no difference between the treatment groups. Patients with lower baseline EQ-visual analog scale (meaning worse QoL) were more likely to be women, self-reported Black and non-European (P<0.001). The strongest independent predictors of a greater improvement in QoL were younger age (P<0.001), no HF hospitalization in the previous year (P<0.001), lower NYHA class before hospital admission (P<0.001) and high-intensity care treatment (mean difference, 4.2 [95% CI, 2.5–5.8]; P<0.001). No statistically significant heterogeneity in the benefits of high-intensity care was seen across patient subgroups of different ages, with left ventricular ejection fraction above or below 40%, NT-proBNP (N-terminal pro-B-type natriuretic peptide) and systolic blood pressure above or below the median value. The treatment effect on the primary end point did not vary significantly across baseline EQ-visual analog scale (P_interaction=0.87).CONCLUSIONS:Early up-titration of guideline-directed medical therapy significantly improves all dimensions of QoL in patients with HF and improves prognosis regardless of baseline self-assessed health status. The likelihood of achieving optimal doses of HF medications does not depend on baseline QoL.REGISTRATION:URL: https://www.clinicaltrials.gov; Unique identifier: NCT03412201.

中文翻译：

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指南指导的药物治疗的快速滴定对生活质量的影响：来自 STRONG-HF 试验的见解

背景：该分析提供了通过 EQ-5D-5L 问卷测量的生活质量 (QoL) 及其组成部分的基线和变化的详细信息，以及与客观结果的关联，对患者进行高强度心力衰竭 (HF) 护理方法：在 STRONG-HF 试验（心力衰竭治疗的安全性、耐受性和快速优化的有效性，NT-proBNP 测试的帮助下）中，急性心力衰竭患者在出院前被随机分配到常规护理或高级护理-指南指导的药物治疗加量的强化护理策略。基线时和 90 天随访时，患者根据 EQ-5D 视觉模拟量表评分对自己的健康状况进行评分，范围从 0（可想象的最差健康状况）到 100（可想象的最佳健康状况）。 结果：1072 名急性心力衰竭患者根据现有的 QoL 评估（539/533 名患者分配高强度护理/常规护理），平均基线 EQ-视觉模拟量表评分为 59.2（SD，15.1），治疗组之间没有差异。基线 EQ-视觉模拟量表较低（意味着生活质量较差）的患者更有可能是女性、自称黑人和非欧洲人（P <0.001）。生活质量更大改善的最强独立预测因素是年龄较小 ( P <0.001)、前一年未因心力衰竭住院 ( P <0.001)、入院前较低的 NYHA 分级 ( P <0.001) 和高强度护理治疗 (平均差异，4.2 [95% CI，2.5–5.8]；P <0.001）。在不同年龄、左心室射血分数高于或低于 40%、NT-proBNP（N 端 B 型钠尿肽前体）和收缩压的患者亚组中，高强度护理的益处没有统计学上的显着异质性压力高于或低于中值。主要终点的治疗效果在基线 EQ-视觉模拟量表中没有显着差异（P_交互作用=0.87）。结论：指南指导的药物治疗的早期滴定显着改善了心力衰竭患者的生活质量的各个方面，并改善了心力衰竭患者的生活质量。预后，无论基线自我评估的健康状况如何。达到心力衰竭药物最佳剂量的可能性并不取决于基线 QoL。注册：URL：https://www.clinicaltrials.gov；唯一标识符：NCT03412201。