PBM Academic Detailing Service Managing Heart Failure in ...

A QUICK REFERENCE GUIDE (2019)

PBM Academic Detailing Service

Managing Heart Failure in Primary Care

Improving Veteran Outcomes Through the Use of Evidence-based Medicine

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Table of Contents

Classifcation of Heart Failure New York Heart Association (NYHA) Functional Classifcation of HF Management of Heart Failure by Stage Mortality-Reducing Medications and Patient Considerations Medications that Reduce Hospitalizations and Patient Considerations Commonly Used Heart Failure Medications ACE Inhibitors (ACEI) ARBs Beta Blockers Aldosterone Antagonists

1 2 3 4 5 6?13 6 7 8 9

i

Diuretics

10

Vasodilators

11

Neprilysin inhibitor/ARB

12

Digoxin and Ivabradine

13

Relative Contraindicated Medications in HFrEF

14

Medications to be Used with Caution in HFrEF

15

Heart Failure Medications in Chronic Kidney Disease

16

Medication Considerations for Treatment of Heart Failure with Preserved Ejection Fraction 17

References

19

ii

Classifcation of Heart Failure (HF)1

Classifcation

Ejection Fraction (EF) (%)

Description

Heart Failure with Reduced Ejection Fraction (HFrEF) Heart Failure with Preserved Ejection Fraction (HFpEF), borderline HFpEF, improved

HFpEF

40

41 to 49

>40, previously 40 50

Systolic HF; evidence that treatment with specifc medication classes reduces mortality and hospitalizations

These patients fall into a borderline or intermediate group Their characteristics, treatment patterns, and outcomes appear similar to those of patients with HFpEF

A subset of patients with HFpEF previously had HFrEF Further research is needed to characterize these patients

Diastolic HF; Management centers around treatment of blood pressure rather than use of specifc medication classes

1

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