Read on Twitter
Need a refresher on #HeartFailure #MedTwitter & #CardioTwitter?
Well @UCSDCardFellows' @QuanBuiMD knows this stuff cold, & took the time out of a busy day of #Cardiac Caths to "guide" our #residents through Guideline-Directed Medical Therapy (GDMT) for #HFrEF!!
Check out
!!
Well @UCSDCardFellows' @QuanBuiMD knows this stuff cold, & took the time out of a busy day of #Cardiac Caths to "guide" our #residents through Guideline-Directed Medical Therapy (GDMT) for #HFrEF!!
Check out
!!
Let's first set a cutoff: for HFrEF, we'll go with EF <40%. Now let's chat about the meds w/ mortality benefit for these patients! Each have different EF cutoffs!
We'll go chronologically.
Remember, for all these studies, that there is a TARGET DOSE shown to have these benefits!
We'll go chronologically.
Remember, for all these studies, that there is a TARGET DOSE shown to have these benefits!
1. ACEi
CONSENSUS in 1987 showed mortality benefit for Enalapril in HFrEF, NYHA 4.
SOLVD in 1991 showed this benefit expanded to those with NYHA 2-3.
Target dose: 10mg BID
#Cardiology #InternalMedicine #MedEd
@pmylavar @JerryLipinski @SonyaJohn9 @hsbhatia @InternalMed_Res
CONSENSUS in 1987 showed mortality benefit for Enalapril in HFrEF, NYHA 4.
SOLVD in 1991 showed this benefit expanded to those with NYHA 2-3.
Target dose: 10mg BID
#Cardiology #InternalMedicine #MedEd
@pmylavar @JerryLipinski @SonyaJohn9 @hsbhatia @InternalMed_Res
2. Beta Blockers
MERIT-HF in 1999 showed Metoprolol Succinate had a mortality benefit in NYHA 2-4.
Target dose: 200mg daily
COPERNICUS in 2001 showed Carvedilol had a mortality benefit in NYHA 3-4.
Target dose: 25mg BID
#MedStudents #MedStudentTwitter
MERIT-HF in 1999 showed Metoprolol Succinate had a mortality benefit in NYHA 2-4.
Target dose: 200mg daily
COPERNICUS in 2001 showed Carvedilol had a mortality benefit in NYHA 3-4.
Target dose: 25mg BID
#MedStudents #MedStudentTwitter
3. Aldosterone Antagonists
RALES in 1999 showed mortality benefit for Spironolactone in NYHA 3-4.
Target dose: 25mg daily
EMPHASIS in 2011 showed mortality benefit for Eplerenone in NYHA 2.
Target dose: 50mg daily
@photon_ick @DirkGainesMD @LukewebsterMd @daniellemunceMD
RALES in 1999 showed mortality benefit for Spironolactone in NYHA 3-4.
Target dose: 25mg daily
EMPHASIS in 2011 showed mortality benefit for Eplerenone in NYHA 2.
Target dose: 50mg daily
@photon_ick @DirkGainesMD @LukewebsterMd @daniellemunceMD
4. ARB (as alternative to ACEi)
VAL-HEFT in 2001 showed mortality (among other) benefits compared to placebo for Valsartan in patients with HFrEF & NYHA class 2-4.
Target dose: 160mg BID
@loridanielsmd @GordonHo_EP @Howie98485139
VAL-HEFT in 2001 showed mortality (among other) benefits compared to placebo for Valsartan in patients with HFrEF & NYHA class 2-4.
Target dose: 160mg BID
@loridanielsmd @GordonHo_EP @Howie98485139
5. Entresto (Sacubatril/Valsartan)
PARADIGM-HF in 2014 showed mortality (among other) benefits compared to ACEi alone in NYHA 2-4.
Target dose: 97/103mg BID
PARADIGM-HF in 2014 showed mortality (among other) benefits compared to ACEi alone in NYHA 2-4.
Target dose: 97/103mg BID
6. SGLT2i
DAPA-HF in 2019 showed mortality (and cardiovascular) benefit compared to placebo in NYHA 2-4.
Target dose: 10mg daily
*While these are not YET in the guidelines, this is COMING SOON!! Check out this handy chart to help you out. Thanks #MedTwitter!!
DAPA-HF in 2019 showed mortality (and cardiovascular) benefit compared to placebo in NYHA 2-4.
Target dose: 10mg daily
*While these are not YET in the guidelines, this is COMING SOON!! Check out this handy chart to help you out. Thanks #MedTwitter!!
