The Safety, Tolerability and Efficacy of Rapid Optimization, Helped by N-Terminal Pro–Brain Natriuretic Peptide Testing of Heart Failure Therapies (The STRONG-HF) trial demonstrated that after ADHF, all efforts should be made to rapidly up titrate to optimal doses of the three and (likely) four pillars of HF medications, combined with close follow-up. This evidence concerns the gene NPPB and hydrops fetalis.