Transcription of MANAGEMENT OF HEART FAILURE with Reduced Ejection …
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MANAGEMENT OF HEART FAILURE with Reduced Ejection …
Updated: January 2019 Review date: December 2021 Page 1 of 28 MANAGEMENT OF HEART FAILURE with Reduced Ejection Fraction (HFREF) All patients with HFREF should be considered for an ACE inhibitor and beta blocker. Introducing one drug at a time, and once the person is stable on the first drug (usually an ACE) then adding the second drug. Aim for the target dose of ACE inhibitor and beta blocker; or, failing that, the maximum tolerated dose. Patients with HEART FAILURE with Reduced Ejection fraction who have ongoing symptoms of HEART FAILURE , despite optimal treatment, should be given mineralocorticoid receptor antagonists (MRA) spironolactone as first line option. No patient should receive three drugs which block the renin-angiotensin-aldosterone system as hyperkalaemia and renal dysfunction will be common. The safety and efficacy of combining an ACE inhibitor, an ARB and MRA is uncertain and the use of these three drugs together is not recommended.
LVAD6, or heart transplantation r action required Consider reducing diuretic dose assessment EF <40% EF <35% Sacubitril/Valsartan 2 to replace ACE-I (or ARB) Evaluate need for CRT3 Ivabradine4 Dapagliflozin10mg OD as add on to ACEI/ARB, BB ±MRA Dapagliflozin 10mg OD as add on to ACEI/ARB, BB ±MRA eGFR>30ml/min
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