New research suggests that rapid uptitration of guideline-directed medical therapy (GDMT) in patients hospitalized for acute heart failure (HF) significantly increases the number of days patients were free of death or HF rehospitalization. Led by Ashok Krishnaswami, MD, from the Kaiser Permanente San Jose Medical Center in San Jose, California, the study's main finding revealed that rapid GDMT uptitration yielded +8.7 extra days (95% confidence interval [CI]: +3.1 to +14.4 days; P=0.002) free of the primary outcome over 6 months compared to usual care. This translated to an increase in restricted mean survival time (RMST) from 157.6 days in the usual care group to 166.3 days in the high-intensity care group. Conveying impact “RMST complements hazard ratio (HR) and risk difference (RD) and can enhance the physician’s ability to convey the real-world impact of interventions to patients and families,” the research letter’s authors said. “Therefore, we believe RMST should be considered for routine inclusion among clinical trial result reporting.” Secondary outcomes also favored the high-intensity care approach, with patients experiencing +6.1 days (95% CI: +1.3 to +10.9 days; P=0.001) free from HF readmission. While acknowledging limitations such as its post hoc nature and the exclusion of certain patient populations, the study concluded that rapid uptitration of GDMT led to a significant gain in event-free days for HF patients. Methodology The study was a post hoc analysis of the international, open-label, randomized STRONG-HF study and included 1,078 patients hospitalized for acute HF, randomized to either high-intensity care or usual care. Eligible participants were 18 to 85 years of age with elevated N-terminal pro-B-type natriuretic peptide levels on hospital discharge and suboptimal HF therapy dosing. High-intensity care involved rapid medication titration to full doses by week 2, with frequent follow-ups. The primary outcome was a composite of all-cause mortality or HF readmission within 180 days. Source: Krishnaswami A, MD. Effect of Uptitration of Recommended Heart Failure Medications on Restricted Mean Survival Time in STRONG-HF. JACC: Heart Fail, 2025;13:873–876. Image Credit: Studio Romantic – stock.adobe.com