ABCD of Pharmacological therapy in Heart Failure


Dr VK Chopra, Gurgaon    30 November 2017

ACEI ARBs ARNI and 946 blockers are neurohormonal modulators and should be used in all patients of HFrEF unless contraindicated as they have been shown to reduce mortality and morbidity. 946 blockers should be instituted when the patient is euvolumeic. Both ACEI ARB ARNI and 946 blockers should be uptitrated to the recommended or maximally tolerated dose while watching for their side effects even if the patients are asymptomatic to reduce mortality. ARNI is a new class of drugs which has been shown to be superior to ACEI in HFrEF. It should be used if patient is symptomatic despite the full dose of ACEI ARB or de novo if a patient can afford it. Diuretics are used in volume overloaded patients. Their dose should be gradually reduced after decongestion to the required minimum. Aldosterone antagonists are to be used in patients who continue to be symptomatic despite adequate doses of ACEI ARB ARNI 946 blockers and diuretics. Frequent monitoring of BP heart rate electrolytes and renal function tests are required in patients on heart failure therapies. Influenza and pneumococcal vaccinations carry a Class I indication but are underused. For HFpEF patients apart from diuretics to reduce symptoms no specific therapies have been shown to reduce mortality and morbidity. As the etiology of HFpEf is varied treatment of comorbidities improves long term results. HFmREF is a newly described entity. Its treatment is being formulated. However in many patients the treatment is similar to HFrEF.

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