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.
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.
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.
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.
In patients with heart failure, guideline-directed medical therapy is often mismanaged during acute decompensation, particularly with regard to beta-blocker therapy. In this entry, we discuss how to manage beta-blockers in patients with acute decompensated heart failure.
In this quick read, we provide an argument for why atenolol should be avoided in patients with compelling indications for beta blocker therapy.
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.
Beta blockers remain a cornerstone in the management of several cardiovascular disorders yet many clinicians are reluctant to use them in the setting of cocaine abuse. In this entry, we take a look at the evidence.
Of the three beta blockers recommended in patients with heart failure with reduced ejection fraction, only carvedilol exerts antagonist effects at α1 receptors. However, its benefits in heart failure are presumably a result of myocardial β1 receptor inhibition, as the β1-selective agents bisoprolol and metoprolol succinate confer similar improvements in morbidity and mortality. So what’s the significance of α1 receptor blockade?
Intravenous diltiazem infusions (i.e., “dilt drips”) are commonly used for the management of atrial tachyarrhythmias but they tend to cause as many problems as they resolve.