TRED Lightly: Should Guideline-Directed Medical Therapy be Continued Indefinitely in Everyone?

The TRED-HF trial considerably narrowed the population deemed as being low risk for heart failure relapse following the withdrawal of guideline-directed medical therapy (GDMT). However, several key subgroups were underrepresented and some patients may still wish to attempt GDMT withdrawal, especially in the setting of adverse effects or excess costs. In this post, we explore three questions that can be used to guide a shared decision-making process regarding GDMT withdrawal.

3 Clinical Pearls For Acute Management of Atrial Fibrillation in Patients with Heart Failure with Reduced Ejection Fraction

Atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF) often occur concomitantly. Despite this, optimal treatment strategies remain unclear. Current rate and rhythm control pharmacotherapy options present challenges when used in patients with HFrEF. In this blog, we cover 3 clinical pearls to consider for acute management of AF in patients with HFrEF.

Can beta-blockers be continued in patients requiring inotropic therapy?

Although beta blockers are considered a fundamental therapy for patients with heart failure (HF), questions remain on how to manage them these medications in patients presenting with decompensation requiring intravenous inotropic therapy. In this post, we will provide some insights on managing the chronic beta blockade and intravenous inotropic therapy when used concomitantly in a decompensated HF patient.

Understanding the IMPACT(-HF) of Initiating GDMT Prior to Discharge

Although admitted patients with heart failure often have acute medical issues (e.g. acute kidney injury, acute decompensation) that may preclude them from certain therapies, many are appropriate candidates for guideline-directed medical therapy (GDMT) before they leave the hospital. This blog discusses the importance of initiating GDMT prior to discharge, whenever possible.

No Love Lost for Intravenous Labetalol Infusions: Risks of Prolonged Use

Labetalol is a beta blocker with potent antihypertensive effects, and it may be administered orally or intravenously. The latter feature makes it especially useful for the acute management of elevated blood pressure but prolonged infusions can result in hemodynamic collapse. In this entry, two cases are discussed and recommendations are made for the appropriate management of continuous labetalol infusions.