169. The Internist's Guide to Heart Failure with Reduced Ejection Fraction (Repeat)
Oct 30, 2022
29:48
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Quick takeaways
2021 guidelines recommend quadruple therapy for heart failure with reduced ejection fraction, integrating ARNIs, beta blockers, mineralocorticoid antagonists, and SGLT2 inhibitors.
Early initiation of guideline-directed medical therapies in a hospital setting with gradual titration for optimal patient outcomes.
Deep dives
The Evolution of Heart Failure Therapy
The 2021 updates to the CCS and CHFS Heart Failure Guidelines have shifted from triple therapy to quadruple therapy for heart failure patients with reduced ejection fraction, integrating ARNIs, beta blockers, mineralocorticoid antagonists, and SGLT2 inhibitors as the foundation of medical management.
Understanding ARNIs and Their Benefits
ARNIs, a combination of sacubitril and valsartan, provide a dual effect by promoting the natriuretic pathway and inhibiting the RAS pathway, leading to significant reductions in cardiovascular death, heart failure hospitalization, and improvements in cardiac remodeling indices compared to ACE inhibitors or ARBs.
Considerations for Medication Initiation and Titration
Initiating guideline-directed medical therapies should commence as early as possible, typically in a hospital setting for optimal monitoring. The titration process involves starting at low doses and gradually increasing every two to four weeks to reach target or maximally tolerated doses over three to six months.
In this episode, Dr. Catherine Leurer interviews Dr. Stephanie Poon (Cardiologist) on the 2021 CCS/CHFS Heart Failure Guidelines Update: Defining a New Pharmacologic Standard of Care for Heart Failure With Reduced Ejection Fraction.
Host: Dr. Catherine Leurer Guest: Dr. Stephanie Poon (Cardiologist) Sound Editing: Krzysztof Kowalik