The role of NT-proBNP in STRONG-HF: targeting the vulnerable phase after acute heart failure (HF)1,2

Post-acute HF vulnerable phase1,2

The period starting with acute HF hospitalisation and the couple of months following, often called the vulnerable period, is a time of increased risk of morbidity and mortality for patients with HF.1

In the 60–90 days after hospital discharge:3

Hospital bed

30% of patients are readmitted


15% die

This is why it is critical that HF patients receive optimal care in their post-acute vulnerable phase with frequent prognostic assessments and close follow-up.4


Seize your window of opportunity with STRONG‑HF1,2


The STRONG-HF, NT-proBNP-led therapeutic strategy offers clinicians guidance on rapid induction and optimisation of GDMT during the vulnerable period before and after discharge, thereby supporting you in providing optimal, life-saving treatment when it is needed most.1

Patient's voice

Learn more about the STRONG‑HF

Biomarker-led therapeutic strategy for HF care.

NT-proBNP offers clinicians precision guidance1,5,6

The STRONG‑HF study demonstrated the strength of combining an intensive treatment protocol with the guardrails of NT‑proBNP monitoring. With frequent NT‑proBNP testing you can strike a balance between being too aggressive or too cautious with your treatment optimisation.1,5

Confidence in proven positive outcomes1

Guided optimisation of GDMT using NT-proBNP significantly contributed to reducing mortality or hospital readmission at 180 days, without increasing the risk of serious adverse events.1


How could this NT-proBNP-led therapeutic strategy transform HF care in your clinic?

Patient doctor

Tailored high-intensity care enabled by baseline stratification6

Gradation of patients based on changes in NT-proBNP measurements can guide the optimisation of different GDMT treatments as well as the dose adjustment of diuretics, helping you fine-tune and tailor therapy for individual patients.6

Thus, NT-proBNP testing within the STRONG-HF treatment strategy allows for personalised care based on each individual patient’s clinical characteristics.6


Rapid initiation of treatment within the post-acute vulnerable phase1

With the STRONG-HF biomarker-led therapeutic strategy, patients with acute heart failure can be quickly up-titrated within weeks of discharge to maximally tolerated doses of GDMT with frequent NT-proBNP testing and strict follow-up.1


Optimising treatment for as many eligible patients as possible1

The STRONG-HF study shows that, with frequent NT-proBNP testing and close follow-up, more patients can be rapidly up-titrated to maximally tolerated doses of GDMT within a few weeks of being discharged, as compared to those under usual care.1


Clarity and control with frequent NT-proBNP testing1

The safety of rapid optimisation within the STRONG-HF trial was guided by NT-proBNP measures in addition to standard assessments.1 NT-proBNP measurements are essential in screening and risk stratification of patients, as well as guiding dose adjustments and monitoring prognosis.1,6


Frequent follow-up now = reduced risk of readmission later1

The high-intensity care strategy required an average of approximately five visits within three months after discharge, compared with an average of one visit during this period with usual care. The effect of more intense management early after admission to hospital for an acute heart failure without up-titration has been examined in four previous reasonably-sized and powered prospective randomised studies. In all these studies, no effect was seen for intensified follow-up alone on endpoints of readmission or death. Therefore, additional early follow-up visits without rapid up-titration to maximally tolerated doses do not seem to affect patient outcomes.7-10

Clinical events

Reduced clinical events regardless of baseline NT-proBNP concentrations6

The STRONG-HF, biomarker-led therapeutic strategy was more efficient than usual care in reducing HF rehospitalisation regardless of baseline NT-proBNP concentrations.6

Despite slow up-titration of GDMT in patients with early increase in NT-proBNP concentrations, high-intensity care was just as beneficial for these patients at 6 months as it was for patients with early decrease in NT-proBNP concentrations.6

STRONG-HF Early Adopters Program (EAP)

Roche Diagnostics is committed to helping clinicians improve patient outcomes through high medical value diagnostic and digital solutions that help you provide your best care. As a leader in in vitro diagnostics, we tackle unmet needs in HF management for you and your patients through innovation and collaboration.

Our STRONG-HF Early Adopters Programme (EAP) will support you in implementing a new HF care pathway, based on the principles of rapid up-titration and close follow-up after discharge. 


GDMT, guideline-directed medical therapy; HF, heart failure; NT-proBNP, N-terminal pro-brain natriuretic peptide



  1. 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, trial. Lancet. 2022;400:1938-52.
  2. Khan MS, et al. Trends in 30- and 90-day readmission rates for heart failure. Circ Heart Fail. 2021;14:e008335.
  3. Greene SJ, et al. The vulnerable phase after hospitalisation for heart failure. Nat Rev Cardiol. 2015;12:220-9.
  4. Maddox TM, et al. 2021 update to the 2017 ACC Expert Consensus Decision Pathway for optimization of heart failure treatment: answers to 10 pivotal issues about heart failure with reduced ejection fraction. J Am Coll Cardiol. 2021;77:772-810.
  5. Richards M, Troughton RW. NT-proBNP in heart failure: therapy decisions and monitoring. Eur J Heart Fail. 2004;6:351-4.
  6. Adamo M, et al. NT-proBNP and high-intensity care for acute heart failure: the STRONG-HF trial. Eur Heart J. 2023;doi:10.1093/eurheartj/ehad335.