The Curbsiders Internal Medicine Podcast #458 HFrEF: Heart Failure with Reduced Ejection Fraction
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Oct 21, 2024 
Dr. Michelle Kittleson, a renowned heart failure expert from Cedars-Sinai, shares her insights on managing heart failure with reduced ejection fraction. She discusses the importance of accurately diagnosing underlying causes and emphasizes personalized medication strategies. The conversation covers the critical role of high-intensity treatment initiation, the efficacy of various drug classes, and the necessity for ongoing patient follow-up. Kittleson also introduces innovative approaches like the 'I Need Help' mnemonic for identifying patients requiring specialized care.
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Managing ARNI Cost and Blood Pressure
- Be transparent with patients about ARNI cost and explore alternatives if needed.
- Advise patients not to check blood pressure at home unless feeling unwell, focusing on symptoms over numbers.
Prioritizing SGLT2i Over ARNI in Cost-Limited Scenarios
- If cost limits access to both ARNI and SGLT2 inhibitor, prioritize the SGLT2 inhibitor and use generic lisinopril.
- This approach leverages the synergistic benefits of the four pillars within cost constraints.
Strong Heart Failure Trial Outcomes
- The Strong Heart Failure trial demonstrated significant benefits from rapid initiation and up-titration of GDMT in hospitalized HFrEF patients.
- Aggressive GDMT optimization within six weeks of hospitalization led to an 8% absolute risk reduction in death and heart failure hospitalization at six months.
