Congestive heart failure Pharmacological treatments for patients with heart failure with reduced ejection fraction: Difference between revisions
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==Overview== | ==Overview== | ||
The major goals of pharmacologic treatment for patients with [[HFrEF]] are reducing [[mortality]], reducing the risk of repeated hospitalizations due to worsening [[HF]], and improving clinical status, [[functional capacity]], and [[quality of life]]. The mainstay of treatment for [[HFrEF]] is the modulation of the [[renin-angiotensin-aldosterone] system] ([[RAAS]]) and [[sympathetic nervous system]]. | |||
==Therapuetic approach== | |||
* The major goals of pharmacologic treatment for patients with [[HFrEF]] are: | * The major goals of pharmacologic treatment for patients with [[HFrEF]] are: | ||
**1) Reducing mortality (either all-cause or | **1) Reducing [[mortality]] (either all-cause or cardiovascular) | ||
**2) Reducing the risk of repeated hospitalizations due to worsening HF | **2) Reducing the risk of repeated hospitalizations due to worsening [[HF]] | ||
**3) Improving clinical status, functional capacity, and quality of life | **3) Improving clinical status, [[functional capacity]], and [[quality of life]] | ||
*The cornerstone of pharmacologic management of [[HFrEF]] is the modulation of the [[renin-angiotensin-aldosterone] system] ([[RAAS]]) and [[sympathetic nervous system]] (i.e., neurohormonal blockade). | |||
==For all patients: To reduce mortality== | |||
[[Angiotensin-converting enzyme inhibitors]] ([[ACE-I]]) or an [[angiotensin receptor-neprilysin inhibitor]] (ARNI), [[beta-blockers]], and [[mineralocorticoid receptor antagonists]] ([[MRA]]) reduce mortality, reduce the risk of repeated HF hospitalizations, and improve symptoms in patients with [[HFrEF]]. Thus, a combination of an ACE-I/ARNI, a beta-blocker, and an MRA is recommended as class I therapies for all [[HFrEF]] patients unless they are contraindicated or not tolerated. These drugs should be uptitrated to the doses used in the clinical trials or to maximally tolerated doses. Unless contraindicated or not tolerated, the [[sodium-glucose co-transporter 2 (SGLT2) inhibitors]] ([[dapagliflozin]] and [[empagliflozin]]) are also recommended for all [[HFrEF]] patients and should be added to pharmacotherapy of [[HFrEF]] patients that are already taking an [[ACE-I]]/[[ARNI]], a [[beta-blocker]], and an [[MRA]], regardless of diabetes status. | [[Angiotensin-converting enzyme inhibitors]] ([[ACE-I]]) or an [[angiotensin receptor-neprilysin inhibitor]] (ARNI), [[beta-blockers]], and [[mineralocorticoid receptor antagonists]] ([[MRA]]) reduce [[mortality]], reduce the risk of repeated [[HF]] hospitalizations, and improve symptoms in patients with [[HFrEF]]. Thus, a combination of an [[ACE-I]]/[[ARNI]], a [[beta-blocker]], and an [[MRA]] is recommended as class I therapies for all [[HFrEF]] patients unless they are [[contraindicated]] or not tolerated. These drugs should be uptitrated to the doses used in the clinical trials or to maximally tolerated doses. Unless contraindicated or not tolerated, the [[sodium-glucose co-transporter 2 (SGLT2) inhibitors]] ([[dapagliflozin]] and [[empagliflozin]]) are also recommended for all [[HFrEF]] patients and should be added to pharmacotherapy of [[HFrEF]] patients that are already taking an [[ACE-I]]/[[ARNI]], a [[beta-blocker]], and an [[MRA]], regardless of [[diabetes]] status. |
Revision as of 11:15, 19 September 2021
Congestive Heart Failure Microchapters |
Pathophysiology |
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Differentiating Congestive heart failure from other Diseases |
Diagnosis |
Treatment |
Medical Therapy: |
Surgical Therapy: |
ACC/AHA Guideline Recommendations
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Specific Groups: |
Congestive heart failure Pharmacological treatments for patients with heart failure with reduced ejection fraction On the Web |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mitra Chitsazan, M.D.[2]
Overview
The major goals of pharmacologic treatment for patients with HFrEF are reducing mortality, reducing the risk of repeated hospitalizations due to worsening HF, and improving clinical status, functional capacity, and quality of life. The mainstay of treatment for HFrEF is the modulation of the [[renin-angiotensin-aldosterone] system] (RAAS) and sympathetic nervous system.
Therapuetic approach
- The major goals of pharmacologic treatment for patients with HFrEF are:
- 1) Reducing mortality (either all-cause or cardiovascular)
- 2) Reducing the risk of repeated hospitalizations due to worsening HF
- 3) Improving clinical status, functional capacity, and quality of life
- The cornerstone of pharmacologic management of HFrEF is the modulation of the [[renin-angiotensin-aldosterone] system] (RAAS) and sympathetic nervous system (i.e., neurohormonal blockade).
For all patients: To reduce mortality
Angiotensin-converting enzyme inhibitors (ACE-I) or an angiotensin receptor-neprilysin inhibitor (ARNI), beta-blockers, and mineralocorticoid receptor antagonists (MRA) reduce mortality, reduce the risk of repeated HF hospitalizations, and improve symptoms in patients with HFrEF. Thus, a combination of an ACE-I/ARNI, a beta-blocker, and an MRA is recommended as class I therapies for all HFrEF patients unless they are contraindicated or not tolerated. These drugs should be uptitrated to the doses used in the clinical trials or to maximally tolerated doses. Unless contraindicated or not tolerated, the sodium-glucose co-transporter 2 (SGLT2) inhibitors (dapagliflozin and empagliflozin) are also recommended for all HFrEF patients and should be added to pharmacotherapy of HFrEF patients that are already taking an ACE-I/ARNI, a beta-blocker, and an MRA, regardless of diabetes status.