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.
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.
Despite being the mainstay of therapy, questions remain as to how to properly use loop diuretics in patients with acute decompensated heart failure (ADHF). In this post, we’ll cover four of the most common mistakes with using loop diuretics in this population.
Of the available agents for treating shock, dopamine remains unusually popular. Although the drug’s varying effects at different doses are thought to afford it several advantages compared to other vasoactive agents, in this post I’ll share three reasons why you should consider replacing dopamine in your practice.
Evidence from randomized controlled trials has demonstrated that the cornerstone pharmacologic therapies used in the management of chronic heart failure with reduced ejection fraction (HFrEF) do not confer the same benefits in patients with preserved ejection fraction (HFpEF). So why do we enroll both subgroups in trials of acute decompensated heart failure (ADHF)? In this entry, we’ll explore differences in pathophysiology between HFrEF and HFpEF and how they may result in variable responses to pharmacologic therapies commonly used in ADHF, particularly diuretics and vasodilators.
In TACTICS-HF, tolvaptan failed to provide a clinically meaningful benefit in patients with acute decompensated heart failure, although patients were enrolled without respect to serum sodium concentrations. Given a consistent trend of disappointing results, does a routine role for the drug exist now or in the future?
In Part 1 of this two-part series, we highlighted some of the limitations of the Diuretic Optimization Strategies Evaluation (DOSE) trial as well as populations in whom continuous infusions of loop diuretics may have advantages over intermittent boluses. In Part 2, we will review some of the disadvantages associated with continuous infusions, as well as pearls for optimally managing them in patients with acute decompensated heart failure.
In the Diuretic Optimization Strategies Evaluation (DOSE) trial, intravenous boluses of loop diuretics were shown to as efficacious and safe as continuous infusions in patients with acute decompensated heart failure. However, the heterogeneity of the population enrolled in DOSE makes it difficult to identify patient populations who might actually benefit from one strategy over another. In Part 1 of this two-part series, we’ll explore several potential populations in whom continuous infusions may be beneficial over intermittent boluses.
The Eighth National Joint Committee recommends a thiazide-type diuretic as one of the first line treatment options for patients with hypertension. However, there is substantial evidence to support the use of a thiazide-like diuretic (e.g., chlorthalidone) over a thiazide diuretic (e.g., hydrochlorothiazide or HCTZ). In this piece, we review the data on why thiazide-like agents should be preferred in this setting.