STRONG-HF Risk Framework Calculator

STRONG-HF Risk Framework — explanation and clinical context This calculator implements a transparent prototype points system that aggregates commonly reported prognostic features relevant to patients hospitalized for acute heart failure (age, hemodynamics at discharge, NT-proBNP, renal function, potassium, LVEF, recent HF hospitalization, and intensity of guideline-directed medical therapy achieved at discharge). It is intended to provide an approximate estimate of the 180-day risk of the STRONG-HF composite outcome (all-cause death or HF readmission) to help identify patients who may benefit most from close follow-up and rapid GDMT optimization. This points system is not a validated risk equation — no multivariable risk equation calibrated from the STRONG-HF trial is published as a usable formula in the primary report — therefore the model below should be considered hypothesis-generating and educational only.

Clinical context: the STRONG-HF randomized trial tested a high-intensity care strategy (rapid up-titration of guideline-directed HF therapies with NT-proBNP-guided monitoring and close follow-up) versus usual care in patients hospitalized with acute HF; the primary endpoint was the composite of HF readmission or death at 180 days, and the intervention reduced that outcome. The trial’s eligibility criteria and prespecified clinical variables (for example, SBP ≥100 mmHg, heart rate ≥60 bpm, potassium ≤5 mmol/L, eGFR ≥30 mL/min/1.73m², and elevated NT-proBNP in many cohorts) influenced the choice of candidate predictors used in this prototype. Use validated, published risk tools (for example GWTG-HF, ADHERE, or other externally validated prognostic models) when an evidence-based risk equation is required for clinical decisions.

Reference(s): Mebazaa A, et al. Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure (STRONG-HF): a multinational, open-label, randomised, parallel-group trial. Lancet.

2022. ClinicalTrials.gov NCT03412201 — STRONG-HF trial registration and protocol. Post-hoc and secondary analyses and contemporary reviews discussing STRONG-HF results, biomarkers and implications for GDMT optimization (examples): Cotter G, et al.

Optimization of Evidence-Based Heart Failure Medications — JAMA Cardiology (post-hoc STRONG-HF analyses).