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CC May 2018 Heart Failure Medical Treatment

echoecho's version from 2018-05-02 03:01


Question Answer
Why do the American College of Cardiology (ACC), the American Heart Association (AHA), and the Heart Failure Society of America (HFSA) issue a focused update to their guidline for the management of heart failure in 2017?The update was prompted by new evidence demonstrating the benefit of a novel class of medications, as well as additional evidence to the guide the management of important comorbidites conditions
What are heart failure patient catergorized by to determine the appropriateness and strength of evidence for various treatment options?EF (ejection fraction) and functional status
Most clinical trials have used EF threshold of either ____ or ____% to define heart failure with reduced ejection fraction, which is distinguished from heart failure with preserved ejection fraction. Give the shortened version of these 2 conditions?HFrEF and HFpEF
Compare HFrEF with HFpEF amount of guide management available?For HFrEF, there are several medications and device therapies with evidence of benefit, however, the evidence for guide management of HFpEF is much more limited
Regarding the functional status of patients, list the levels from the New York Heart Association Heart Failure Classification System?LEVEL I = heart failure symptoms do not limit activity. LEVEL II = slight limitation of activity. Symptoms provoked by ordinary levels of activity. LEVEL III = marked limitation of activity. Symptoms provoked even by low levels of activity. LEVEL IV = Severe limitation of activity. Symptoms are either present at rest or provoked by any level of exertion
What is the initial therapy for HFrEF?ACEI or ARB PLUS Carvedilol (Corey), metoprolol succinct (Toprol XL), or Bisoprolol (Zebeta)
In regards to the above question, for patients who remain symptomatic (NYHA class II or worse), what class of medications can be considered based on patient characteristics?Aldosterone antagonists can reduce all-cause mortality and should be considered in patients in NYHA class II through IV. Clontraindications are GFR < 30 or K > 5.0. It is recommended to replace ACE or ARB therapy with a combination angiotensin receptor blockade neprilysin inhibitor (ARNI)
What is the only available as of this writing of a combination angiotensin receptor blocker / neprilysin inhibitor (ARNI)?Sacubitril / Vallarta (Entresto)
Comparing Enalapril (Vasotec) with Sacubitril / valsartan (Entresto), comment on morbidity and mortality?Sacubitril / valsartan (Entresto) reduced mortality and orbiting compared to monotherapy with Enalapril (Vasotec)
Sacubitril / valsartan (Entresto) is contraindication in what type of patient?1) those receiving concomitant ACEI or ARB 2) those with a hx of angioedema
The addition of a combination of ______ and ______ is indicated to reduce morbidity in AA w/ NYHA class III or IV HFrEF?Hydralazine; nitrates
Finally, the addition of ________ may reduce hospital admissions for heart failure in selected patients?Ivabradine (Corlanor)
Ivabradine (Corlanor) acts by what?Inhibiting the If current in the sinoatrial node, causing a reduction in heart rate
Ivabradine is indicated in patients with an EF < ___% whose heart rate remains > ____/min despite beta blocker therapy at the maximally tolerated dose?35%; 70
What were the findings of mortality differences associated with Ivabradine (Corlanor) use compared to placebos or beta-blocker therapy?No mortality differences associated w/ Ivabradine (Corlanor) use compared w/ placebo or beta-blocker therapy
The new guidelines also incorporates recent evidence on the management of comorbidites HTN and _____?Anemia
The Systolic Blood Pressure INtervention Triial (SPRINT) study (published in 2015) found that intensive BP control reduced adverse cardiovascular events and overall mortality compared to standard control in patients at high risk of cardiovascular events, true or false?True
Although symptomatic heart failure and EF < 35% were both exclusion criteria for SPRINT, the guideline authors recommend what?Titration antihypertensive medications to achieve a SBP < 130, based on evidence from SPRINT that this strategy was beneficial in other categories of patients with high cardiovascular risk
Two randomized trials found that IV _____ therapy improved functional status and quality of life in patients w/ iron deficiency anemia?Iron
Based on the negative results of a large randomized trial, the ACC/AHA/HFSA guideline recommends against the use of what agents to correct anemia?Erythropoietin-stimulating
The evidence to guide management of HFpEF is limited, there is weak evidence to support the use of what medication?Spironolactone
The TOPCAT trial showed what regarding spironolactone?1) use of Spironolactone did not lead to a statistically significant reduction in a composite endpoint; however, there was a marginal reduction in hospitalization for heart failure (one component of the composite outcome). 2)A prespecified subgroup analysis noted a reduction in the primary outcome in patients who were enrolled based on an elevated BNP. 3) Post hoc analyses noted regional variation in patient characteristics and study quality
Based on these findings, the current guideline gives a class II b recommendations (indicating limited evidence for the use of spironolactone to reduce hospital admissions in selected patients w/ HFpER
Question Answer
The guideline notes limited evidence of ARBS can reduce ______ in patients with HFpEF?hospitalizations
A single randomized trial of candesartan for HFpEF failed to show an improvement in the primary outcome but did show an improvement in what (a secondary outcome)?heart failure hospitalization
The guidelines for HFpEF recommends against the use of what 2 drugs?1) nitrates 2) phosphodiesterase inhibitors
Has Atenolol (Tenormin), Amlodipine (Norvasc) been specifically evaluated for HFpEF?no
*** SUMMARY = There are 2 categories of heart failure, list these?1) heart failure with reduced EF (HFrEF) < 40%. 2) heart failure with preserved ejection fraction (HFpEF) > 50%
*** SUMMARY = Patients with HFrEF are traditionally treated with what? a combination of ACEI or an ARB, beta blocker, diuretics and aldosterone antagonist.
*** SUMMARY = The combination of an ARB with a neprilysin inhibitor, ____________, is no recommended to replace ACEI or ARB for symptomatic patients? sacubitril-valsartan (Entresto)
*** SUMMARY = Patients with HFpEF are best managed with treatment of hypertension along with diuretics for volume overload
Question Answer
*** SUMMARY = Patients with HFpEF are best managed with what med to decrease the hospitalization rate?Aldosterone antagonist (Spironolactone (Aldactone))