Congestive heart failure other pharmacotherapies

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Congestive Heart Failure Microchapters

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Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Systolic Dysfunction
Diastolic Dysfunction
HFpEF
HFrEF

Causes

Differentiating Congestive heart failure from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Clinical Assessment

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

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Cardiac MRI

Echocardiography

Exercise Stress Test

Myocardial Viability Studies

Cardiac Catheterization

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Other Diagnostic Studies

Treatment

Invasive Hemodynamic Monitoring

Medical Therapy:

Summary
Acute Pharmacotherapy
Chronic Pharmacotherapy in HFpEF
Chronic Pharmacotherapy in HFrEF
Diuretics
ACE Inhibitors
Angiotensin receptor blockers
Aldosterone Antagonists
Beta Blockers
Ca Channel Blockers
Nitrates
Hydralazine
Positive Inotropics
Anticoagulants
Angiotensin Receptor-Neprilysin Inhibitor
Antiarrhythmic Drugs
Nutritional Supplements
Hormonal Therapies
Drugs to Avoid
Drug Interactions
Treatment of underlying causes
Associated conditions

Exercise Training

Surgical Therapy:

Biventricular Pacing or Cardiac Resynchronization Therapy (CRT)
Implantation of Intracardiac Defibrillator
Ultrafiltration
Cardiac Surgery
Left Ventricular Assist Devices (LVADs)
Cardiac Transplantation

ACC/AHA Guideline Recommendations

Initial and Serial Evaluation of the HF Patient
Hospitalized Patient
Patients With a Prior MI
Sudden Cardiac Death Prevention
Surgical/Percutaneous/Transcather Interventional Treatments of HF
Patients at high risk for developing heart failure (Stage A)
Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B)
Patients with current or prior symptoms of heart failure (Stage C)
Patients with refractory end-stage heart failure (Stage D)
Coordinating Care for Patients With Chronic HF
Quality Metrics/Performance Measures

Implementation of Practice Guidelines

Congestive heart failure end-of-life considerations

Specific Groups:

Special Populations
Patients who have concomitant disorders
Obstructive Sleep Apnea in the Patient with CHF
NSTEMI with Heart Failure and Cardiogenic Shock

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Risk calculators and risk factors for Congestive heart failure other pharmacotherapies

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]

Overview

Nutritional supplements and hormonal supplements have not been proved to be of any benefit in patients with heart failure and reduced left ventricular ejection fraction.

2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure

Nutritional Supplements and Hormonal Therapies in Patients Presenting With Heart Failure (DO NOT EDIT)

Class IIb
"1. In patients with HF class II to IV symptoms, omega-3 polyunsaturated fatty acid (PUFA) supplementation may be reasonable to use as adjunctive therapy to reduce mortality and cardiovascular hospitalizations. [1][2][3][4] (Level of Evidence: B-R) "
Class III (No Benefit)
"2. In patients with HFrEF, vitamins, nutritional supplements, and hormonal therapy are not recommended other than to correct specific deficiencies. [5][6][7][8][9][10][11] (Level of Evidence: B-R) "

Vote on and Suggest Revisions to the Current Guidelines

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References

  1. ↑ Macchia A, Levantesi G, Franzosi MG, Geraci E, Maggioni AP, Marfisi R; et al. (2005). "Left ventricular systolic dysfunction, total mortality, and sudden death in patients with myocardial infarction treated with n-3 polyunsaturated fatty acids". Eur J Heart Fail. 7 (5): 904–9. doi:10.1016/j.ejheart.2005.04.008. PMID 16087142.
  2. ↑ Tavazzi L, Maggioni AP, Marchioli R, Barlera S, Franzosi MG, Latini R; et al. (2008). "Effect of n-3 polyunsaturated fatty acids in patients with chronic heart failure (the GISSI-HF trial): a randomised, double-blind, placebo-controlled trial". Lancet. 372 (9645): 1223–30. doi:10.1016/S0140-6736(08)61239-8. PMID 18757090. Review in: Ann Intern Med. 2009 Jan 20;150(2):JC1-11
  3. ↑ Bhatt DL, Steg PG, Miller M, Brinton EA, Jacobson TA, Ketchum SB; et al. (2019). "Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia". N Engl J Med. 380 (1): 11–22. doi:10.1056/NEJMoa1812792. PMID 30415628.
  4. ↑ Peterson BE, Bhatt DL, Steg PG, Miller M, Brinton EA, Jacobson TA; et al. (2021). "Reduction in Revascularization With Icosapent Ethyl: Insights From REDUCE-IT Revascularization Analyses". Circulation. 143 (1): 33–44. doi:10.1161/CIRCULATIONAHA.120.050276. PMC 7752247 Check |pmc= value (help). PMID 33148016 Check |pmid= value (help).
  5. ↑ Djoussé L, Cook NR, Kim E, Bodar V, Walter J, Bubes V; et al. (2020). "Supplementation With Vitamin D and Omega-3 Fatty Acids and Incidence of Heart Failure Hospitalization: VITAL-Heart Failure". Circulation. 141 (9): 784–786. doi:10.1161/CIRCULATIONAHA.119.044645. PMC 7054158 Check |pmc= value (help). PMID 31709816.
  6. ↑ Wang T, Liu Z, Fu J, Min Z (2019). "Meta-analysis of vitamin D supplementation in the treatment of chronic heart failure". Scand Cardiovasc J. 53 (3): 110–116. doi:10.1080/14017431.2019.1612084. PMID 31032644.
  7. ↑ Zittermann A, Ernst JB, Prokop S, Fuchs U, Gruszka A, Dreier J; et al. (2019). "Vitamin D supplementation of 4000 IU daily and cardiac function in patients with advanced heart failure: The EVITA trial". Int J Cardiol. 280: 117–123. doi:10.1016/j.ijcard.2019.01.027. PMID 30654912.
  8. ↑ Lonn E, Bosch J, Yusuf S, Sheridan P, Pogue J, Arnold JM; et al. (2005). "Effects of long-term vitamin E supplementation on cardiovascular events and cancer: a randomized controlled trial". JAMA. 293 (11): 1338–47. doi:10.1001/jama.293.11.1338. PMID 15769967.
  9. ↑ Marchioli R, Levantesi G, Macchia A, Marfisi RM, Nicolosi GL, Tavazzi L; et al. (2006). "Vitamin E increases the risk of developing heart failure after myocardial infarction: Results from the GISSI-Prevenzione trial". J Cardiovasc Med (Hagerstown). 7 (5): 347–50. doi:10.2459/01.JCM.0000223257.09062.17. PMID 16645413.
  10. ↑ Mortensen SA, Rosenfeldt F, Kumar A, Dolliner P, Filipiak KJ, Pella D; et al. (2014). "The effect of coenzyme Q10 on morbidity and mortality in chronic heart failure: results from Q-SYMBIO: a randomized double-blind trial". JACC Heart Fail. 2 (6): 641–9. doi:10.1016/j.jchf.2014.06.008. PMID 25282031.
  11. ↑ Madmani ME, Yusuf Solaiman A, Tamr Agha K, Madmani Y, Shahrour Y, Essali A; et al. (2014). "Coenzyme Q10 for heart failure". Cochrane Database Syst Rev (6): CD008684. doi:10.1002/14651858.CD008684.pub2. PMID 24049047.
  12. ↑ Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW (May 2022). "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". Circulation. 145 (18): e895–e1032. doi:10.1161/CIR.0000000000001063. PMID 35363499 Check |pmid= value (help).
  13. ↑ Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202
  14. ↑ Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 119 (14):1977-2016. DOI:10.1161/CIRCULATIONAHA.109.192064 PMID: 19324967

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