Please select the option that best describes you:
In patients who are on 3 of the 4 pillars of HF therapy for HFrEF, would you add the 4th pillar if they are no longer in symptomatic HF and LVEF normalizes?
The basis of the question is that HFrEF trials enroll patients who have Class II-IV symptoms. If their LV systolic function recovers and they become asymptomatic, would adding the 4th pillar still be warranted?
Answer from: at Community Practice
Adding a fourth agent offers no proven advantage, and will increase the chance of side effects and drug interactions.
It can always be added later if symptoms develop, or EF falls.
Answer from: at Community Practice
This is a very good question without much data. Certainly, those patients on 4 agents who improved or recovered should be continued based on the TRED-HF trial. Now, I can see the potential lack of benefit in asymptomatic patients (NYHA I) whose LVEF has normalized. In a non-ischemic patient, I proba...
Answer from: at Community Practice
While I agree with what was written already, my take on this matter is that the situation should not occur in current times.
In our practice, we strive to start all 4 pillars within 2-4 weeks and have ARNI/BB doses maximized by week 6 in order to get the full effect and benefit of hospitalization a...
Comments
at Healthy Heart LLC
I haven’t done that unless they were hyperte...
I haven’t done that unless they were hyperte...
However, if they improve to Class I but still have...
The problem is hypotension and hyperkalemia give m...
Well the problem with leaving MRA last is that you...
Although SGLT2 are having better insurance coverag...
The only valid reason for not adding the 4th pilla...
I would beg to differ. There’s no studies to...
Also, not HF but I think PARADIGM was soft (both f...