HF Basics
The 4 core pillars of HFrEF therapy.
What are ACEi/ARB/ARNi, beta-blocker, SGLT2i, aldosterone antagonist (+/- loop diuretics)?
This ARNI has been shown to reduce hospitalizations and mortality in HFrEF compared with enalapril.
What is sacubitril/valsartan (Entresto)?
A daily habit that all HF patients should be counseled on to detect worsening symptoms.
What is daily weight monitoring?
This is the ideal timeframe in which heart failure patients should have a follow-up appointment after hospital discharge.
What is within 7 days?
Ejection fraction (EF) cutoff that defines HFrEF.
What is EF ≤ 40%?
For the treatment of heart failure with reduced ejection fraction, this is the correct once-daily dose of dapagliflozin or empagliflozin.
What is 10 mg once daily?
The recommended daily sodium intake for most HF patients.
What is ~2 g sodium per day (some guidelines: <2–2.3 g/day)?
This is the most common reason heart failure patients are readmitted to the hospital after discharge.
What is medication nonadherence or suboptimal medication management?
Two classic symptoms of heart failure.
What is dyspnea, fatigue, edema (any two)?
The three beta-blockers that have evidence in heart failure.
Lab values that should be monitored closely in patients on loop diuretics.
What are electrolytes (potassium, magnesium, sodium) and renal function?
A patient meeting criteria for spironolactone is discharged without a prescription for it. This is the transition-of-care problem that occurred.
What is omission of guideline-directed medical therapy?
A patient presents with EF 55%, dyspnea on exertion, and hypertension. Identify the type of HF.
What is HFpEF?
This aldosterone antagonist is selective and does not exhibit endocrine side effects.
What is eplerenone?
When switching a patient from an ACE inhibitor to sacubitril/valsartan (Entresto), this washout period is required to prevent angioedema.
What is 36 hours?
A patient leaves the hospital without understanding their new medication regimen. This type of pharmacist-led intervention could help prevent readmission.
What is teach-back counseling or providing a reconciled list of medications to the patient?
A medication class that should be avoided in HFrEF due to negative inotropic effects.
What are non-dihydropyridine calcium channel blockers (verapamil, diltiazem)?
These medications/medication classes are used in heart failure primarily to improve symptoms, but they do not confer a survival benefit.
What are diuretics (ex. loops) and digoxin?
These cardiac biomarkers are measured to diagnose and monitor heart failure: one is biologically active, and the other is its inactive precursor. What are they?
What are BNP and NT-proBNP?
This is the key medication optimization you’d recommend for a patient being discharged on lisinopril, furosemide, and metoprolol tartrate.
What is switching metoprolol tartrate to metoprolol succinate?