Patient-Centered Heart Failure Therapy.
| Autor: | Samson R; Advanced Heart Failure Therapies Program, University of Louisville Health-Jewish Hospital, Ky., Ennezat PV; Department of Cardiology, AP-HP Hopitaux Universitaires Henri Mondor, Créteil, France., Jemtel THL; Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, La. Electronic address: lejemtel@tulane.edu. |
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| Jazyk: | angličtina |
| Zdroj: | The American journal of medicine [Am J Med] 2024 Jan; Vol. 137 (1), pp. 23-29. Date of Electronic Publication: 2023 Oct 12. |
| DOI: | 10.1016/j.amjmed.2023.09.018 |
| Abstrakt: | Simultaneous initiation of quadruple therapy with angiotensin receptor-neprilysin inhibitor, beta-adrenergic receptor blocker, mineralocorticoid receptor antagonist, and sodium glucose cotransporter 2 inhibitor aims at prompt improvement and prevention of readmission in patients hospitalized for heart failure with reduced ejection fraction. However, titration of quadruple therapy is time consuming. Lengthy up-titration of quadruple therapy may negate the benefit of early initiation. Quadruple therapy should start with a sodium glucose cotransporter 2 inhibition and a mineralocorticoid antagonist, as both enable safe decongestion and require minimal or no titration. Depending on the level of decongestion and clinical characteristics, patients receive an angiotensin receptor-neprilysin inhibitor or a beta-adrenergic receptor blocker to be titrated after hospital discharge. Outpatient addition of an angiotensin receptor-neprilysin inhibitor to a beta-adrenergic receptor blocker or vice versa completes the quadruple therapy scheme. By focusing on decongestion and matching intervention to patients' profile, the present therapeutic sequence allows rapid implementation of quadruple therapy at fully recommended doses. (Copyright © 2023 Elsevier Inc. All rights reserved.) |
| Databáze: | MEDLINE |
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