Medscape InDiscussion: Heart Failure S1 Episode 1: Quadruple Therapy in Heart Failure With Reduced Ejection Fraction: Don't Back Down
23 snips
Jan 10, 2023 Cutting‑edge discussion of quadruple therapy for heart failure with reduced ejection fraction. Clear talk on timing and dose optimization of ARNI/ACEi/ARB, beta blockers, MRA, and SGLT2 inhibitors. Practical strategies to overcome therapeutic inertia, manage low blood pressure and transient creatinine rises. System solutions like telehealth and rapid uptitration models are highlighted.
AI Snips
Chapters
Books
Transcript
Episode notes
Quadruple Therapy Is The New Foundation For HFrEF
- Optimal GDMT requires rapid initiation and optimization of four classes of therapy for HFrEF: beta blocker, MRA, SGLT2 inhibitor, and RAS inhibition (ARNI/ACEi/ARB).
- Dr. Other Speaker notes benefits appear within 30 days and include reduced CV death, fewer HF hospitalizations, improved QoL, renal protection, and reverse remodeling.
Start All Four Classes Early Rather Than Waiting
- Do initiate the four GDMT classes early and either simultaneously at low doses or sequentially tailored to the patient rather than following trial-era sequencing.
- Other Speaker emphasizes time is of the essence because benefits can be seen as early as within a month.
Don't Call Heart Failure Patients Stable Use Disease Modification
- Avoid therapeutic inertia and do not label patients as 'stable' to justify withholding ARNI or SGLT2 inhibitors when on ACEi and beta blocker.
- Other Speaker compares complacency to leaving active cancer untreated and stresses missing early mortality/hospitalization benefits is disservice.
