Congestive heart failure pharmacotherapy: Difference between revisions

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*Indications for use of an [[ARNI]]
*:[[Heart failure]] reduced [[EF]] ([[HFrEF]]) ([[LVEF]] ≤ 40%)
*: [[NYHA]] 2-4 [[heart failure]]
*: Use in place of [[ACEI]] or [[ARB]] for combination therapy of [[heart failure]]
*Indications for Use of Ivabradine
*: [[Heart failure]] reduced [[EF]] ([[EF]]≤ 35%)
*:On maximum tolerated dose of [[beta-blocker]]
*:[[Sinus rhythm]] with a resting [[heart rate]] ≥ 70 beats/min
*:[[ NYHA]] class II or III [[HF]]
*Indications for Use of an [[SGLT2 Inhibitor]]
*:[[HFrEF]] (EF ≤40%) with or without [[diabetes]]
*:[[NYHA]] class II–IV [[HF]]
*: Combined with other treatment of [[heart failure]]
*Dose adjustment of [[sacubitril-valsartan]]
*: 49/51 twice daily:
*:: Previous use of high dose of [[ACEI]] or [[ARB]]: [[valsartan]] 160 mg daily or [[enalapril]] 10 mg daily
*: 24/46 mg twice daily:
*:: [[valsartan]]<160 mg daily, [[enalapril]] < 10 mg daily
*:: No previous use of [[ACEI]] or [[ ARB]]
*::Severe [[renal]] impairment ([[eGFR]] <30 mL/min/1.73 m2)
*::Moderate [[hepatic]] impairment (Child-Pugh Class B)
*::[[Elderly]] (age ≥75 years)





Revision as of 03:59, 15 December 2021

Congestive Heart Failure Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Systolic Dysfunction
Diastolic Dysfunction
HFpEF
HFrEF

Causes

Differentiating Congestive heart failure from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Clinical Assessment

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

Cardiac MRI

Echocardiography

Exercise Stress Test

Myocardial Viability Studies

Cardiac Catheterization

Other Imaging Studies

Other Diagnostic Studies

Treatment

Invasive Hemodynamic Monitoring

Medical Therapy:

Summary
Acute Pharmacotherapy
Chronic Pharmacotherapy in HFpEF
Chronic Pharmacotherapy in HFrEF
Diuretics
ACE Inhibitors
Angiotensin receptor blockers
Aldosterone Antagonists
Beta Blockers
Ca Channel Blockers
Nitrates
Hydralazine
Positive Inotropics
Anticoagulants
Angiotensin Receptor-Neprilysin Inhibitor
Antiarrhythmic Drugs
Nutritional Supplements
Hormonal Therapies
Drugs to Avoid
Drug Interactions
Treatment of underlying causes
Associated conditions

Exercise Training

Surgical Therapy:

Biventricular Pacing or Cardiac Resynchronization Therapy (CRT)
Implantation of Intracardiac Defibrillator
Ultrafiltration
Cardiac Surgery
Left Ventricular Assist Devices (LVADs)
Cardiac Transplantation

ACC/AHA Guideline Recommendations

Initial and Serial Evaluation of the HF Patient
Hospitalized Patient
Patients With a Prior MI
Sudden Cardiac Death Prevention
Surgical/Percutaneous/Transcather Interventional Treatments of HF
Patients at high risk for developing heart failure (Stage A)
Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B)
Patients with current or prior symptoms of heart failure (Stage C)
Patients with refractory end-stage heart failure (Stage D)
Coordinating Care for Patients With Chronic HF
Quality Metrics/Performance Measures

Implementation of Practice Guidelines

Congestive heart failure end-of-life considerations

Specific Groups:

Special Populations
Patients who have concomitant disorders
Obstructive Sleep Apnea in the Patient with CHF
NSTEMI with Heart Failure and Cardiogenic Shock

Congestive heart failure pharmacotherapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Congestive heart failure pharmacotherapy

CDC on Congestive heart failure pharmacotherapy

Congestive heart failure pharmacotherapy in the news

Blogs on Congestive heart failure pharmacotherapy

Directions to Hospitals Treating Congestive heart failure pharmacotherapy

Risk calculators and risk factors for Congestive heart failure pharmacotherapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]

Overview

The following table summarized the stepwise treatment for heart failure.

Congestive heart failure treatment summary based on 2021 ACC/AHA Guideline

Pathophysiology Treatment
Renin-angiotensin-aldosterone system ARNIs/ACEIs/ARBs, aldosterone

antagonist

Sympathetic nervous system Beta-blockers
Natriuretic and other vasodilator peptides Neprilysin inhibitor (ARNI)
Sodium-glucose cotransporter-2 SGLT2 inhibitors
Balanced vasodilation and oxidative stress modulation Hydralazine/Isosorbide dinitrate
Elevated heart rate Betablocker, Ivabradine
Guanylyl cyclase Soluble guanylyl cyclase stimulator
Relief of congestion Diuretic
Ventricul;ar arrhythmia Implantable cardioverter defibrilator
Ventricular dyssynchrony due to conduction abnormalities Cardiac resynchronization therapy
Mitral regurgitation Surgical or percutaneous Mitral repair
Reduced aerobic capacity Aerobic exercise training


Sacubitril/Valsartan Ivabradine SGLT2 Inhibitors
Contraindications Contraindications Contraindications
Causions
  • Renal impairment:
    Mild-to-moderate (eGFR 30-59 mL/ min/1.73 m2): no starting dose adjustment required
  • Severe (eGFR <30 mL/min/ 1.73 m2):
    Reduce starting dose to 24/26 mg twice daily,
    Double the dose every 2–4 weeks to target maintenance dose of 97/103 mg twice daily, as tolerated
  • Hepatic impairment:
    Mild (Child-Pugh A): no starting dose adjustment required
    Moderate (Child-Pugh B):
    Reduce starting dose to 24/26 mg twice daily
    Double the dose every 2–4 weeks to target maintenance dose of 97/103 mg twice daily, as tolerated
  • Renal artery stenosis
  • Systolic blood pressure <100 mm Hg
  • Volume depletion
Causions Causions

For prevention of ketoacidosis in patients with diabetes:

erythema, or swelling in the genital or perineal area, along with fever or malaise














Acute Decompensated Chronic
HFpEF
HFrEF

References

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