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Initiation, Continuation, Switching, and Withdrawal of Heart Failure Medical Therapies During Hospitalization.

Publication ,  Journal Article
Bhagat, AA; Greene, SJ; Vaduganathan, M; Fonarow, GC; Butler, J
Published in: JACC Heart Fail
January 2019

Patients with worsening heart failure with reduced ejection fraction (HFrEF) spend a large proportion of time in the hospital and other health care facilities. The benefits of guideline-directed medical therapy (GDMT) in the outpatient setting have been shown in large randomized controlled trials. However, the decision to initiate, continue, switch, or withdraw HFrEF medications in the inpatient setting is often based on multiple factors and subject to significant variability across providers. Based on available data, in well-selected, treatment-naïve patients who are hemodynamically stable and clinically euvolemic after stabilization during hospitalization for HF, elements of GDMT can be safely initiated. Inpatient continuation of GDMT for HFrEF appears safe and well-tolerated in most hemodynamically stable patients. Hospitalization is also a potential time for switching from an angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker to sacubitril/valsartan therapy in eligible patients, and is the subject of ongoing study. Therapy withdrawal or need for dose reduction is rarely required, but if needed identifies a particularly at-risk group of patients with progressive HF. If recurrent intolerance to neurohormonal blockers is observed, these patients should be evaluated for advanced HF therapies. There is an enduring need for using the teachable moment of HFrEF hospitalization for optimal initiation, continuation, and switching of GDMT to improve post-discharge patient outcomes and the quality of chronic HFrEF care.

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Published In

JACC Heart Fail

DOI

EISSN

2213-1787

Publication Date

January 2019

Volume

7

Issue

1

Start / End Page

1 / 12

Location

United States

Related Subject Headings

  • Valsartan
  • Tetrazoles
  • Stroke Volume
  • Practice Guidelines as Topic
  • Mineralocorticoid Receptor Antagonists
  • Medication Adherence
  • Humans
  • Hospitalization
  • Heart Failure
  • Drug Substitution
 

Citation

APA
Chicago
ICMJE
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Bhagat, A. A., Greene, S. J., Vaduganathan, M., Fonarow, G. C., & Butler, J. (2019). Initiation, Continuation, Switching, and Withdrawal of Heart Failure Medical Therapies During Hospitalization. JACC Heart Fail, 7(1), 1–12. https://doi.org/10.1016/j.jchf.2018.06.011
Bhagat, Aditi A., Stephen J. Greene, Muthiah Vaduganathan, Gregg C. Fonarow, and Javed Butler. “Initiation, Continuation, Switching, and Withdrawal of Heart Failure Medical Therapies During Hospitalization.JACC Heart Fail 7, no. 1 (January 2019): 1–12. https://doi.org/10.1016/j.jchf.2018.06.011.
Bhagat AA, Greene SJ, Vaduganathan M, Fonarow GC, Butler J. Initiation, Continuation, Switching, and Withdrawal of Heart Failure Medical Therapies During Hospitalization. JACC Heart Fail. 2019 Jan;7(1):1–12.
Bhagat, Aditi A., et al. “Initiation, Continuation, Switching, and Withdrawal of Heart Failure Medical Therapies During Hospitalization.JACC Heart Fail, vol. 7, no. 1, Jan. 2019, pp. 1–12. Pubmed, doi:10.1016/j.jchf.2018.06.011.
Bhagat AA, Greene SJ, Vaduganathan M, Fonarow GC, Butler J. Initiation, Continuation, Switching, and Withdrawal of Heart Failure Medical Therapies During Hospitalization. JACC Heart Fail. 2019 Jan;7(1):1–12.
Journal cover image

Published In

JACC Heart Fail

DOI

EISSN

2213-1787

Publication Date

January 2019

Volume

7

Issue

1

Start / End Page

1 / 12

Location

United States

Related Subject Headings

  • Valsartan
  • Tetrazoles
  • Stroke Volume
  • Practice Guidelines as Topic
  • Mineralocorticoid Receptor Antagonists
  • Medication Adherence
  • Humans
  • Hospitalization
  • Heart Failure
  • Drug Substitution