The Curbsiders Internal Medicine Podcast #458 HFrEF: Heart Failure with Reduced Ejection Fraction
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Oct 21, 2024 
Dr. Michelle Kittleson, a renowned heart failure expert from Cedars-Sinai, shares her insights on managing heart failure with reduced ejection fraction. She discusses the importance of accurately diagnosing underlying causes and emphasizes personalized medication strategies. The conversation covers the critical role of high-intensity treatment initiation, the efficacy of various drug classes, and the necessity for ongoing patient follow-up. Kittleson also introduces innovative approaches like the 'I Need Help' mnemonic for identifying patients requiring specialized care.
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Identify Underlying Causes of Cardiomyopathy
- Determine the underlying cause of newly diagnosed cardiomyopathy, as it can significantly impact treatment and prognosis.
- Consider common causes like coronary artery disease, thyroid issues, diabetes, HIV, and hemochromatosis.
Guide Diuresis by Physical Exam, Not BNP
- Use BNP to support or exclude a heart failure diagnosis, but avoid guiding diuresis based on serial BNP measurements.
- Base diuresis decisions on physical exam findings like JVP, edema, and patient-reported symptoms.
Rapid Sequence Initiation of GDMT
- Prioritize rapid sequence initiation of ARNI, MRA, and SGLT2 inhibitor for heart failure with reduced ejection fraction.
- Start beta-blockers after optimizing other therapies, as they don't offer immediate symptomatic relief.
