Pharmacologic heart failure treatment: A case-based review of current guidelines

Heart failure (HF) is a growing health problem associated with high morbidity and mortality. Use of evidence-based therapies improves clinical outcomes in patients with HF with reduced ejection fraction (HFrEF). However, in real-world research studies, adults with HFrEF were often medically undermanaged, including failure to use the right medications and failure to up titrate core HF therapies to doses similar to those used in randomized controlled trials. Although guidelines provide best-practice statements about care management, nurse practitioners and physician assistants (NPs and PAs) and clinical nurses often have questions about how to implement guideline-directed therapies in patient care management. With emerging new medications for managing HFrEF, and the possibility of new medications for patients with HF with preserved ejection fraction, complexity of care management will continue to increase. The aims of this review are to provide a summary of the 2017 updates to the national chronic HF management guidelines and use a case-based approach to discuss treatment change considerations associated with optimal guideline-based clinical care.