The STRONG-HF study highlights three key points in the management of decongestion in acute HF: (1) the introduction of GDMT, after initial management with intravenous diuretics, may already start in the emergency room with the start of full dose of SGLT2 inhibitors and half dose of MRAs, if possible; (2) the combination of the four GDMT drugs should be initiated during the index hospital stay; and (3) all efforts should be made to achieve full doses of the four pillars of HF within 6 weeks [70]. This evidence concerns the gene SLC5A2 and hydrops fetalis.