The American College of Cardiology has published a new update to its consensus decision pathway for the treatment of heart failure with reduced ejection fraction .theheart.org | Medscape Cardiology
Rather than focusing on extensive text, the document provided practical tips, tables, and figures to make clear the steps, tools, and provisos needed to treat patients with heart failure successfully and expeditiously, they added. The four pillars of therapy are ARNI, a beta-blocker, a mineralocorticoid antagonist, and an SGLT inhibitor.
"In all patients with heart failure and reduced ejection fraction, getting them on all four of these medicines as quickly as possible will give the best outcome. We've seen evidence in support of this from several broad population trials," he added. "There are times when they can't take all four but we should do our best to get there.
He gave the example of mineralocorticoid antagonists, which can sometimes elevate potassium levels, particularly if there is some underlying kidney disease, so clinicians are advised to recommend a low-potassium diet for these patients or the use of potassium binding agents that will also lower the amount of potassium in the blood stream; in this way, patients are able to continue the mineralocorticoid antagonist.
"Patients do not want to come back and forth to the doctor's office multiple times in a few weeks. This is often a nonstarter, particularly for patients with busy lives," he commented. "If you start giving patients seven, eight, or nine different medicines that they have to take every day, sometimes multiple times a day — that's complicated medically, logistically, and financially. The potential for interaction and complications increases with every additional medication."