ABCD of Pharmacological Therapy in Heart Failure


Dr VK Chopra, Gurugram    19 December 2017

should be used in all HFrEF patients unless contraindicated, as they have been shown to reduce mortality and morbidity.

β blockers should be instituted when the patient is euvolumeic. Both ACEI/ARB/ARNI and β 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 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, β blockers and diuretics.

Frequent monitoring of BP, heart rate, electrolytes and renal function tests are required in patients on HF 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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