Hydralazine-nitrate combination for heart failure with a reduced ejection fraction – does formulation matter?

Teaser: Does the formulation of oral nitrate therapy matter when used for patients with heart failure with reduced ejection fraction (HFrEF)? Should fixed-dose hydralazine (HYD)/isosorbide dinitrate (ISDN) (BiDil®) be used in those with HFrEF or can the medications be prescribed separately? In clinical practice the individual components HYD and ISDN are often prescribed as a result of cost concerns with the brand name, fixed-dose combination product. Additionally, clinicians often substitute extended-release isosorbide mononitrate (ISMN) for ISDN given its less frequent administration schedule. In this post we will discuss whether these formulations can be used interchangeably in those 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.

Transitions Squared: Transitioning Sacubitril/Valsartan at Transitions of Care

One of the questions that remained unanswered after the PARADIGM-HF trial was whether the angiotensin receptor/neprilysin inhibitor sacubitril/valsartan could be safely initiated in patients with acute decompensated heart failure who had been previously stabilized on an angiotensin-converting enzyme (ACE) inhibitor or angiotensin II receptor blocker. In this blog, Dr. Reed discusses the implications of the PIONEER-HF and TRANSITION studies, and provides a practical strategy for transitioning patients to sacubitril/valsartan.

Getting to the Heart of the Patient Interview: A Focus on Heart Failure (Part II)

A thorough and accurate patient assessment is critical to managing patients with heart failure. In this second post of our two-part series, we’ll focus on volume status and adherence to medications and dietary recommendations. Check out our first post for general principles and an assessment of functional status. A template collection tool is also provided.