Therapeutics of HF Flashcards
What is gold standard for diagnosing HF?
Echocardigography
Why don’t we have evidence based therapies for HFpEF?
Inclusion criteria for trials was EF
When can you rule out HF?
Normal ECG and Normal BNP
Prognosis of HF vs cancers
HF prognosis is worse than every other cancer except lung cancer
Medical therapies for HF
ACEi
Aldosterone antagonists
B-blockers
Next step after medical therapy in HF
Exercise training (some evidence) ±CRT-P/D Cardiac resynchronisation therapy Extra pacemaker lead, improves function of heart by taking a dysynchronous ventricle and making it contract to give a more useful cardiac output P (pacing) D (defibrillator) Usually both
First line treatment in HF
ACEi
standard procedure but could give b-blocker first also
CI of ACEi
Angioedema (v rare)
Bilateral renal artery stenosis
Pregnancy/risk of pregnancy
Cautions with ACEi
Hyperkalaemi, renal dysfunction, severe hypotension
How often are beta blockers given in HF
Pretty much everyone
CI of beta blocker
Asthmatics
2/3rd degree AV block/conduction block
What stage of therapy are aldosterone antagonists in HF
3rd class
Why would you give aldosterone antagonists in HF?
To more severe HF
Is COPD a CI for beta blocker?
NO
Why do patients not take HF medication well
mage of HF does not carry connotations that it is actually worse than most cancers
Difference between observation data and RCT
Confounding in observational. RCT only sure way to tell if a drug works
Decrease in risk of death in HF patient by taking carvedilol
35% - huge
Why are less pts on beta blockers in US?
Payment at point of care
How are side effects leaflets in medication packets decided on? Problem with this?
Questionnaires to patients. Not scientifically based. Regression to mean of symptoms
What role to clinicians play in compliance of taking medication?
More clinicians mention the adverse effects than the benefit. Pts will definitely live substantially longer with the treatment than without it
B blocker increase in survival in HF?
5 months
ACEi increase in survival in HF?
6months
Cumulative addition of HF drug therapy
Triple therapy triples life span
Why are RCTs not representative of the population being treated
Young, reliable, articulate patients
Problem with elderly in RCTs
Therapeutic effect will fall due to other coexisting disease
Normal practice for ACE-I/ARB/aldosterone antagonists
To start: Accept Cr<220 and K>5.5
Keep SBP>90mmHg
Once started accept Cr<266, K5.5
Next option after triple therapy
LCZ696 (entresto) A combination of
• Valsartan (ARB)
• Sacubitril (neprilysin inhibitor)
