Share this post:Author: Sandeep Devabhakthuni, PharmD, BCCP Since the 2017 American College of Cardiology (ACC) Expert Consensus Decision Pathway (ECDP) for Optimization of Heart Failure Treatment was published, new evidence for novel therapies for HFrEF has demonstrated overwhelmingly positive clinical
Share this post: Created by: Kristin Watson PharmD, BCCP Reviewed by: Zachary R. Noel, PharmD, BCCP Share this post:
Share this post:Created by: Brent N. Reed PharmD, BCCP Reviewed by: Michael Plazak, PharmD, BCCP Share this post:
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.
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.
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.
In the time since our last post on this topic, two randomized controlled trials have been conducted to test the effects of early vasodilator therapy in patients with acute decompensated heart failure, and both came up short. But is this a failure of the drugs themselves or were the populations simply too diverse to detect an effect?
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.
Questions regarding the role of sodium-glucose co-transporter-2 inhibitors (SGLT2i) in heart failure have been raised since the publications of EMPA-REG OUTCOME in 2015. The recent results of the Study to Evaluate the Effect of Dapagliflozin on the Incidence of Worsening Heart Failure or Cardiovascular Death in Patients With Chronic Heart Failure (DAPA-HF) shed some light on the potential for these medications in HFrEF. In this blog, we discuss the implications of DAPA-HF and the role of SGLT2i for heart failure, including perspectives from a cardiologist.
Cardiovascular disease is the leading cause of morbidity and mortality in patients with end stage renal disease (ESRD). A significant number of patients with ESRD undergoing dialysis have reduced left ventricular ejection fraction. Contemporary treatment of heart failure with reduced ejection fraction (HFrEF) includes multiple pharmacotherapeutic strategies such as renin-angiotensin-aldosterone system inhibitors to reduce mortality and slow disease progression. However, because of concerns about hyperkalemia, aldosterone receptor antagonists are not commonly used in patients with HFrEF and ESRD undergoing dialysis. This blog summarizes the current evidence for efficacy and safety of aldosterone receptor antagonists in patients with concomitant HFrEF and ESRD requiring dialysis.