Clinical Trials
Landmark trials DAPA-HF (2019) and EMPEROR-REDUCED (2020) proved the benefit of which class of medication in HFrEF with or without T2DM?
SGLT2i
What is the equation for cardiac output (CO)?
CO = HR x SV
What is the medical terminology for shortness of breath that occurs while lying down?
Orthopnea
Name the classes of the “4 Pillars” used in HFrEF.
(1) ARNi/ACEi/ARB, (2) BB, (3) MRA, (4) SGLT2i
When a patient is undergoing aggressive diuresis, what electrolyte will likely require replacement?
Potassium
Which class of medications recommended in the guidelines does NOT have proven mortality benefits in heart failure?
Loop diuretics
Activation of what system is responsible for cardiac remodeling?
RAAS
Jugular venous distension (JVD) is associated with (right/left-sided) heart failure?
Right-sided
Name the three evidence-based beta blockers for heart failure.
bisoprolol, carvedilol, and metoprolol succinate (Toprol XL)
Name the class of medications with negative inotropic actions that can cause or exacerbate heart failure.
Non-DHP CCBs (diltiazem and verapamil)
The 2022 EMPULSE trial found that empagliflozin (should/should not) be initiated in patients with acute decompensated heart failure.
Should, additional decongestion (weight loss) with no safety concerns.
Name the most common cause of heart failure.
Coronary artery disease
What amount of weight gain in a 24-hour period AND weekly period is concerning for an exacerbation?
>2–3 lbs in 24-hours or 5 lbs in a week
What is the goal serum digoxin level for heart failure?
0.5-0.9 ng/mL
Patients with HFimpEF should be treated according to the guidelines for HFrEF, HFmrEF, or HFpEF?
HFrEF
The EMPEROR-REDUCED trial used a composite measure of HF hospitalization and CV death as a primary outcome. What endpoint is driving statistical significance?
Primary composite outcome HR (95% CI): 0.79 (0.69-0.90)
HF Hospitalization, HR (95% CI): 0.71 (0.60-0.83)
CV death, HR (95% CI): 0.91 (0.76-1.09)
HF hospitalization
Define chronotropic and ionotropic effects.
Chronotropy (rate) influences (force)
Following the “sick day rule” by holding the dose of an SGLT2i when the patient is unwell (vomiting, diarrhea, fever) reduces the risk of which adverse effect?
Diabetic ketoacidosis (DKA)
What medication is included as part of GDMT in African American patients (NYHA III – IV)?
Isosorbide dinitrate/ Hydralazine (BiDil)
What are the eGFR cutoffs for use for empagliflozin and dapagliflozin?
dapagliflozin, eGFR <25 mL/min/1.73 m2
empagliflozin, eGFR <20 mL/min/1.73 m2
PARADIGM-HF evaluated sacubitril-valsartan versus enalapril. Calculate the number needed to treat (NNT) using the following information:
NNT 22
Eccentric remodeling is associated with which type of heart failure?
HFrEF or systolic heart failure
If a patient has newly diagnosed heart failure with symptoms of edema and SOB at rest, what ACC/AHA stage AND NYHA class is this patient?
Stage C, Class IV
What is the dose equivalence of PO furosemide: torsemide: bumetanide?
40:20:1
What is the washout period when converting from ACEi to ARNi?
36 hours