A global clinical trial has led to a significant shift in the treatment of heart failure in the UK. The approach, already adopted in some NHS hospitals, delivers higher doses of medication earlier—dramatically improving patient outcomes.
A new medical protocol is being adopted by select NHS hospitals following a landmark international study into heart failure care. The method, known as “rapid titration”, prioritises faster drug escalation in the early stages of treatment, showing a substantial reduction in patient mortality.
The Strong-HF trial, involving 87 hospitals across 14 countries, has prompted hospitals in London and Swansea to revise their standard care for heart failure patients. The condition, which affects around one million people in the UK, occurs when the heart struggles to pump blood efficiently, often leading to severe fatigue and breathlessness.
Higher Initial Doses Lead To Sharper Reductions in Deaths and Hospitalisations
The Strong-HF trial demonstrated that providing optimal doses of medication within the first two weeks of diagnosis can significantly improve patient outcomes. According to the findings, this method reduced mortality by 62% and cut hospital readmissions by 30% when compared to the traditional gradual dose increase over several months.
Historically, heart failure patients in the UK were started on low doses, with medication levels slowly increased over a 9- to 12-month period.
“In days gone by, we would start patients on a very low dose and increase it by very small doses,” said Matthew Sunter, lead heart failure nurse at St George’s Hospital in London. “Strong-HF has allowed us to think completely differently.”
Sunter explained that the updated protocol enables patients to be reviewed one week after discharge, allowing clinicians to intervene early if complications arise. This swift response window, according to Sunter, provides a safety net that was previously missing.
At St George’s, the new approach has already been applied to 14 patients, with plans to extend it to 100 more annually.
Eligibility and Application Remain Selective, but Impact Is Substantial
The method is not suitable for all patients. Dr Parin Shah, a cardiologist at Morriston Hospital in Swansea, noted that while the new approach shows “considerable” benefits, it involves strong medications that require careful patient screening.
“Some people may not be able to tolerate such intensive treatment,” said Shah. Blood pressure and kidney function are checked before patients can begin the rapid titration plan.
Despite its limitations, the NHS sees this approach as a valuable step forward. According to Professor Simon Roy, NHS England’s national clinical director for heart disease, the treatment “could transform the health outlook for thousands of people.”
Hospitals implementing the new protocol include Morriston, which aims to treat 500 patients this year from the Swansea and Neath Port Talbot areas. The Department of Health and Social Care described the adoption as evidence of the NHS “at the forefront of global medical innovation.”
