Formulary Decisions Matter: 4 reasons to add SGLT2i to your inpatient formulary

Several advances in the pharmacologic treatment of heart failure with reduced ejection fraction (HFrEF) have been made in the past several years. Despite known benefits, use of guideline-directed medical therapy in these patients remains wildly suboptimal. There are several reasons for this, including increasing complexity of HF regimens as well therapeutic inertia. While we may not have control over all components of therapeutic inertia, we feel strongly as a pharmacist that we cannot let our inpatient formulary decisions be one of them. As such, here we discuss 4 reasons why you should add these agents to formulary.

A Sticky Situation: The Role of Thrombolytics in Left Ventricular Assist Device Thrombosis

Pump thrombosis is a potentially life-threatening complication of continuous-flow left ventricular assist device support. Escalation of antithrombotic therapy has historically been associated with variable efficacy and high rates of bleeding. Previous guidelines suggest thrombolytic therapy as an alternative treatment option in patients with device thrombosis in whom surgical device exchange would result in unacceptable operative risk. This blog will explore the use of thrombolytics for pump thrombosis and highlight important factors to consider with this strategy.

Managing Septic Shock in Patients with a Broken Heart: Focus on Hemodynamic Management with Fluids and Vasoactive Agents

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Currently, national guidelines do not address sepsis management in patients with underlying heart failure with reduced ejection fraction (HFrEF). Several factors make the management of sepsis in patients with HFrEF uniquely challenging, including a heightened risk of volume overload and the need for alternative vasoactive regimens to maintain cardiac output. The purpose of this blog is to provide practical considerations in the hemodynamic management of septic patients with HFrEF using fluids and vasoactive agents.

Help or Hype: Vericiguat for Heart Failure with Reduced Ejection Fraction

The recently published VICTORIA study assessed the efficacy and safety of vericiguat, a soluble guanylate cyclase stimulator in patients with heart failure with reduced ejection fraction, and met its primary composite outcome of death from cardiovascular causes or first hospitalization for heart failure. This blog describes four reasons why despite a technically positive study, I’m not sure I see a significant role for vericiguat in this population.

Say It Ain’t (Mostly) So? DOAC therapy for Stroke Prevention in Patients with Liver Disease and Atrial Fibrillation

Use of oral anticoagulation therapy in patients with liver disease is complex. The risks and benefits of therapy need to be considered as those with liver disease can be at heightended risk of bleeding. This blog post will review the literature surrounding the use of oral anticoagulation in patients with atrial fibrillation and liver disease and recommendations on selecting therapy, if any, will be discussed.