The HFrEF Standard of Care
An expert in the management of heart failure discusses the standard of care for patients with reduced ejection fraction.
EP: 1.Heart Failure Clinical and Economic Burden
EP: 2.The Progressive Nature of Heart Failure
EP: 3.Link Between LVEF, NT-ProBNP and Cardiac Remodeling
EP: 4.Improved Understanding of Heart Failure
EP: 5.Treatment Goals for Patients With Heart Failure
EP: 6.The HFrEF Standard of Care
EP: 7.Heart Failure Management Unmet Needs
EP: 8.Utilization Management Strategies for Appropriate Treatment
EP: 9.Challenges in the Management of HFpEF
EP: 10.Differences in Standard of Care: HFpEF vs HFrEF
EP: 11.Ensuring Timely and Appropriate Access to Therapy
EP: 12.Differences in Economic Burden: HFpEF and HFrEF
EP: 13.PROVE-HF Trial Overview
EP: 14.PARAGON-HF Trial Overview
EP: 15.Recent Findings from the PARALLAX Study
EP: 16.Promising Findings From the TOPCAT Study
EP: 17.Differences in Leading Treatments for Heart Failure
EP: 18.When to Add an SGLT2 Inhibitor to Treatment Regimen
EP: 19.Heart Failure Sites of Care
EP: 20.How Approved Agents Will Change the Standard of Care
EP: 21.Heart Failure Management During COVID-19
John McMurray, MBChB: In patients with heart failure and reduced ejection fraction, we have what some people have recently been calling the 5 alive: the 5 pharmacological approaches that improve survival. These can be given in 4 pills. First is a renal angiotensin system blocker. Today we would couple that with a neprilysin inhibitor, and those 2 treatments can be prescribed in 1 pill: sacubitril-valsartan. Next is a beta-blocker with a mineral corticoid receptor antagonist or aldosterone antagonist. Most recently, the fifth of those pharmacological approaches is an SGLT2 inhibitor. In addition, we have other drugs that improve symptoms and reduce the risk of heart failure hospitalization, but they don’t reduce mortality. Good examples of that would be ivabradine, digoxin, and most recently, a treatment called vericiguat. We may see also new ideas about intravenous iron very shortly, so that may also be added to that list. We also have devices that we use selectively in certain patients that improve survival, and these are implantable cardioverter variation defibrillators and cardiac resynchronization therapy. We’ve got a wealth of life-saving treatments, and a wealth of treatments that improve symptoms and reduce hospital admission.
