Guideline Based Medicine
What are the 4 pillars of HFrEF treatment
ACE/ARB/ARNi
Beta Blockers
MRAs
SGLT2i
How often should pts medications be titrated
meds should be assessed at every appointment, up to every 2 weeks
This lab value should be monitored within 2 weeks of the initiation of an ACEi, ARB, or ARNi
Potassium
Patients should be informed that it can take how long for symptom improvement after starting a beta blockers
Weeks to months
What SGLT2i have proven benefit in heart failure
Jardiance and Farxiga
At what ejection fraction is it considered HFrEF
<40%
4 pillars
5th pillar in specific population
vericiguat
This laboratory biomarker is often elevated in heart failure and trends can help track treatment response
proBNP or BNP
How long do you have to hold doses between the conversion of an ACE--> ARNi, ARB-->ARNi
36 hours
next dose
What are the three beta blockers with HF benefits
metoprolol succinate
carvedilol
bisoprolol
What is the only medication class with mortality reduction with HFpEF
SGLT2i
How often should beta blockers be titrated
every 2 weeks
Patients on loop diuretics should be told to monitor this daily at home
weight
What patients are contraindicated to the use of SGLT2i
Type 1 diabetics
This class of medication has proven benefit in preload and afterload reduction
ACE/ARB/ARNi
What medication is recommended to be added to pts with HR >70 despite max dose beta blockers and can help reduce hospitalizations
ivabridine
what is the starting dose and max dose of SGLT2i in HF
10 mg
what is the eGFR cut off for the SGLT2s
Jardiance= 20***
What is a common ADR with MRAs and how can you minimize the risk
gynecomastia
eplerenone > spironolactone
what part of the nephron do SGLT2i work on
proximal tubule
What is considered the 5th pillar of therapy in African American individuals
hydralazine with isosorbide dinitrate
What is the target dose of metoprolol? carvedilol? bisoprolol
Metoprolol- 200 mg qday
Bisoprolol- 10 mg qday
Coreg- 25 mg BID (<85kg) or 50 mg BID
A rise in creatinine of up to this percentage is considered normal and acceptable after the initiation of an ACEi/ARB/ARNi
30%
What patients are contraindicated to the use of ACEi/ARB/ARNi
Pregnancy
What meds are commonly added on for symptom management
loop diuretics
digoxin