Contemporary post-discharge management in heart failure at home (STRONG@HOME)
J Rolland, T Ovrebotten, K Berge, H Nahoui, O A Bjorkelund, K Broch, G Cotter, J Ezekowitz, S Halvorsen, C S P Lam, T Omland, A Mebazaa, J Munkhaugen, H Schirmer, P L MyhreAbstract
Background
The post-discharge period after heart failure (HF) hospitalisation is associated with high-risk, and the uptake of guideline-directed medical therapy (GDMT) remains suboptimal. In the STRONG-HF trial, an intensive strategy of rapid GDMT up-titration and close follow-up after an acute HF admission reduced the risk of all-cause mortality and HF readmissions compared to usual care. Based on the STRONG-HF results, this strategy received a Class IB recommendation in the 2023 Focused Update of the ESC HF Guidelines, but requires substantial resources and may offer logistical challenges. Whether follow-up visits can safely be performed virtually at home and still achieve the same degree of GDMT without excess adverse events remains unknown.
Objectives
This abstract describes the design and methodological framework of STRONG@HOME. This trial evaluates whether patients discharged after hospitalisation for acute HF can safely achieve the same level of GDMT via digital follow-up at home as compared to hospital visits, according to the STRONG-HF strategy.
Methods
STRONG@HOME is a randomised, multicentre, open-label, parallel group trial. In total, 462 patients hospitalised for acute HF will be randomised in a 1:1 ratio to receive digital (experimental arm) or in-person (control arm) follow-up at 1-, 2-, 3- and 6-weeks post-discharge (See Figure). Patients in the control arm are followed at outpatient HF clinics, while patients in the experimental arm are followed up via video consultations and telemonitoring. The dual primary outcomes (Bonferroni corrected with 0.025 as significance level) are assessed for non-inferiority after 90 days at the final follow-up visit. Efficacy is measured by the GDMT-score (0-9), based on four drug classes. Safety is assessed as treatment-emergent adverse events, including eGFR <30 mL/min/1.73 m², systolic BP <95 mm Hg, heart rate <50 bpm, and serum potassium >5.5 mmol/L. The expected median GDMT-score in the control arm is 7 (SD 2.5). With a 10% non-inferiority margin, a sample size of 404 is needed for 80% power and a significance level of 0.025. For safety, a 51% expected adverse events rate requires a sample size of 416. At an expected 10% dropout rate, the final overall target sample size is 462. Per January 1, 2026, 83 patients have been enrolled, and all sites are activated.
Conclusion
STRONG@HOME is the first study to assess if patients with acute HF can safely achieve the same level of GDMT through digital home follow-up as through hospital visits, using the STRONG-HF strategy. This approach could enable broader implementation of guideline-recommended post-discharge management at reduced cost, improve accessibility for patients in rural or underserved areas, and alleviate capacity constraints at specialised HF clinics. Digital follow-up may also enhance patient convenience and adherence while maintaining clinical outcomes, potentially transforming post-discharge HF care delivery at scale.Strong@Home flow chartFor image description, please refer to the figure legend and surrounding text.