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Heart Failure VI: Adjunct Therapies

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Patient-Centered Heart Failure Therapy.

Rohan Samson¹, Pierre V Ennezat², Thierry H Le Jemtel³

¹Advanced Heart Failure Therapies Program, University of Louisville Health-Jewish Hospital, Ky.

The American Journal of Medicine

|October 14, 2023

Summary

This summary is machine-generated.

Initiating quadruple therapy for heart failure with reduced ejection fraction can be streamlined. A new sequence prioritizes safe decongestion and rapid titration, ensuring patients receive optimal heart failure treatment doses sooner.

Keywords:

Guideline-directed medical therapy Heart failure with reduced ejection fraction Quadruple therapy Titration

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Area of Science:

Cardiology
Pharmacology
Internal Medicine

Background:

Heart failure with reduced ejection fraction (HFrEF) requires complex medication regimens.
Quadruple therapy (angiotensin receptor-neprilysin inhibitor, beta-adrenergic receptor blocker, mineralocorticoid receptor antagonist, SGLT2 inhibitor) improves outcomes but is challenging to titrate.
Delayed titration of quadruple therapy may hinder early benefits in HFrEF patients.

Purpose of the Study:

To propose an optimized sequence for initiating quadruple therapy in hospitalized HFrEF patients.
To facilitate rapid implementation and up-titration of guideline-directed medical therapy.
To improve patient outcomes and reduce hospital readmissions through timely medication optimization.

Main Methods:

A novel therapeutic sequence starting with SGLT2 inhibitors and mineralocorticoid receptor antagonists for safe decongestion.
Phased introduction of angiotensin receptor-neprilysin inhibitors or beta-adrenergic receptor blockers based on patient decongestion status.
Outpatient titration to complete quadruple therapy, optimizing medication doses for HFrEF management.

Main Results:

The proposed sequence allows for safe decongestion and minimal initial titration.
Facilitates prompt initiation of key HFrEF medications.
Enables rapid achievement of target doses for quadruple therapy, improving treatment efficiency.

Conclusions:

A structured, sequential approach to quadruple therapy initiation is feasible and beneficial for HFrEF patients.
This strategy addresses the challenges of timely medication titration in heart failure care.
Optimizing quadruple therapy initiation can enhance clinical outcomes and reduce healthcare utilization.