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Medication dosing for heart failure with reduced ejection fraction - opportunities and challenges
Catherine N Marti1, Gregg C Fonarow2, Stefan D Anker3
1Piedmont Heart Institute and University of Georgia, Athens, GA, USA.
European Journal of Heart Failure
|December 12, 2018
Summary
Managing multiple heart failure medications is complex. Achieving target doses requires careful consideration of patient factors and potential side effects for optimal treatment outcomes.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Multiple drug classes offer benefits for heart failure with reduced ejection fraction.
- Clinical trials often target specific drug doses, which guidelines recommend for practice.
- Increasing therapeutic options present challenges in simultaneous dosing and side effect management.
Purpose of the Study:
- To discuss the dosing of heart failure medications in clinical trials versus practice.
- To provide recommendations for navigating complex therapeutic decision-making in heart failure management.
Main Methods:
- Review of existing data on heart failure medication doses from clinical trials.
- Analysis of dosing variability in clinical practice.
- Discussion of factors impacting target dose achievement.
Main Results:
- Significant variability exists between target doses in trials and achieved doses in practice.
- Factors like blood pressure, renal function, and hyperkalemia impede achieving target doses.
- Guideline-directed therapy eligibility often requires stability on maximally tolerated background doses.
Conclusions:
- Navigating complex polypharmacy in heart failure requires strategic sequencing and dosing.
- Addressing barriers to target dose achievement is crucial for effective heart failure management.
- Recommendations are provided to aid clinicians in complex therapeutic decision-making.
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