CHF charts

Question 1

tx path for HFpEF

in order of first recc to last

Answer 1

symptomatic HF w/LVEF <= 50%
- diuretics as needed (1)
- SGLT2i (2a)
- ARNi (2b)
- MRA (2b)
- ARB (2b)

Question 2

tx path for HFmrEF

in order first recc to last

Answer 2

symptomatic HF w/LVEF 41-49%
- diuretics as needed (1)
- SGLT2i (2a)
- ACEi, ARB, ARNi (2b)
- MRA (2b)
- evidence based Beta Blockers for HFrEF (2b)

Question 3

tx path for LVEF <=40%
- first and second step

Answer 3

FIRST:
- establish HFrEF dx
- adress congestion
- start guideline directed medical tx (GDMT)
—> ARNI or ACEi, Beta blocker, MRA, SGLT2i, Diuretics as needed

SECOND
- titrate (gradually inc doses to target, monitor labs and LVEF)

Question 4

what pt scenarios need what kind sof alt therapies

Answer 4

African American patients (NYHA III–IV): Add hydralazine + nitrates

NYHA II–III with QRS ≥150 ms and LBBB: Consider CRT-D

NYHA II–III with LVEF ≤35% and >1-year survival: Consider ICD

Question 5

reassess sx, labs, LVEF
- refractory HF v. sx improved what step next

Answer 5

refractory–> durabloe MCS, cardiac transplant, palliative care

sx improve—> continue GDMT and reasses/optimize doses w goals