New evidence is available to guide heart failure (HF) management.
Beta-natriuretic peptide (BNP) is recommended to screen at risk patients (IIaB), on admission (IA), and prior to discharge (IIaB).
The combination of ARB and neprilysin inhibitor (ARB-NI) is recommended in symptomatic patients with HF with reduced ejection fraction (HFrEF) who are tolerant of ACE inhibition (IB). For these patients, transitioning from ACE-inhibitor to the ARB-NI combination, valsartan-sacubitril significantly reduced hospitalization and mortality. Optimal dose and titration strategies remain unclear. ARB-NIs should not be used in patients with a history of angioedema (IIIC) or within 36 hours of receiving ACE-inhibitors (IIIB).
Ivabradine, a selective inhibitor of the HCN channel (mixed sodium and potassium channel that carries the If current) in the sinoatrial node, is recommended to reduce hospitalizations for patients with HFrEF with stable symptoms with resting sinus heart rate greater than or equal to 70 despite maximally-tolerated beta-blockade (IIaB).
Intravenous iron replacement is recommended to improve function and quality of life for patients with symptomatic HF and iron deficiency (IIbB).
HF optimization is a collaborative venture between patient and physician. The medical regimen requires periodic adjustments and careful monitoring. Unfortunately this is not achieved in many cases, leading to symptoms exacerbation and ultimately hospital admissions. Partner with an experienced Arlington Heights physician to optimize your HF management.