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?
Which Patients with Heart Failure Should Get Loop Diuretics as a Continuous Infusion? (Part 2)
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.
Which Patients with Heart Failure Should Get Loop Diuretics as a Continuous Infusion? (Part 1)
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.
Are Dipeptidyl Peptidase (DPP)-4 Inhibitors Safe in Patients with Heart Failure?
Significant focus has been placed on the cardiovascular effects of various treatment options for type 2 diabetes. One topic of concern is the risk of heart failure (HF) associated with dipeptidyl peptidase-4 (DPP-4) inhibitors. This piece reviews the literature on DDP-4 inhibitor therapy and the risk of HF and HF hospitalization. Suggestions on how to apply the literature to practice are also provided.
Now on Our YouTube Channel: Cardiac Preload, Afterload, and Contractility
Have you or your learners struggled to understand preload, afterload, and cardiac contractility? If so, check out our new YouTube videos!
Digoxin defended: why make a SHIFT to ivabradine?
Following publication of the 2016 update to the American College of Cardiology Foundation / American Heart Association guidelines for the management of patients with heart failure, there’s been growing interest in the use of ivabradine, particularly to reduce the risk of rehospitalization for heart failure. But haven’t we had access to an agent that prevents heart failure rehospitalizations for a long time now? In this entry, we’ll explore how digoxin can fill an important niche in the management of patients with heart failure who remain at high risk for readmission despite optimal guideline-directed medical therapy.
Sacubitril/Valsartan in Advanced Heart Failure
Sacubitril/valsartan reduces the risk of hospitalizations and cardiovascular death in patients with symptomatic heart failure, but what is its role in advanced disease, as management strategies shift to a palliative plan of care? In this piece, we will discuss the role of sacubitril/valsartan in patients living with advanced disease.
Carvedilol and Alpha Blockade: Does it Matter in the Long Run?
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?
The Trouble with Diltiazem Infusions
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.
A Problem in PARADIGM-HF: What about Black Patients?
In PARADIGM-HF, a combination of the neprilysin inhibitor sacubitril and the angiotensin receptor blocker valsartan reduced cardiovascular death and hospitalizations for heart failure compared to the ACE inhibitor enalapril. But by studying so few black patients, who have historically responded less favorably to many heart failure drugs, can we trust its widespread use in this population?