Heart Failure (HFrEF) Treatment - GDMT for stage C
For patients with Heart Failure with REDUCED Ejection Fraction (HFrEF), we follow Guideline-Directed Medical Therapy (GDMT). GDMT is basically getting patients on medication regimens that have been evidenced to have a mortality benefit, while also considering adding other agents for morbidity benefits when appropriate. In patients with HFrEF, we should initiate them on ACEI or ARB and an evidenced beta-blocker since these have mortality benefits. It's important to have both of these medications on board, then titrate them up to the target dose (as tolerated). If patients have edema then add on loop diuretics. After a patient is on maximally tolerated ACEI/ARB + Beta-Blocker, we can move to the next section of possible agents. Agents with mortality benefit in second-line include Entresto (replacing ACEI/ARB), spironolactone, and BiDil (for African American patients). Additionally we can consider adding ivabradine if patients HR is still >70 despite the beta blocker. This process is recommended by the ACC/AHA guidelines. We may also consider digoxin for morbidity benefits in certain situations as well.
Jarred Prudencio, PharmD - https://www.instagram.com/ambcarerx
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