Heart Failure Essentials for Advanced Practice Providers-GDMT Management and Novel Therapies

Video Transcription

Video Summary

In this video, Sandy McCrary discusses the guideline-directed medical therapy for heart failure. Sandy starts by reviewing the classifications of heart failure based on ejection fraction, including HFREF (reduced ejection fraction), heart failure with mildly reduced ejection fraction, and HFPEF (preserved ejection fraction). She emphasizes that guideline-directed medical therapy should be started immediately upon diagnosis of heart failure and that delaying therapy can lead to never initiating it. Sandy discusses the guidelines provided by the American College of Cardiology, the American Heart Association, the Heart Failure Society of America, and the European Society of Cardiology, which outline drug choices, doses, and target doses for heart failure patients. She highlights the importance of following these guidelines as they have been shown to reduce hospitalizations, improve morbidity and mortality, and enhance functional capacity. Sandy also discusses the various medications used to address the pathophysiological mechanisms of heart failure, including beta blockers, ACE inhibitors, ARBs, ARNIs, aldosterone antagonists, and SGLT2 inhibitors. She explains the dosing and monitoring considerations for each medication. Sandy also mentions the use of combination hydralazine plus isosorbide therapy in certain populations, such as self-identified African-American patients. She briefly discusses the role of device therapy in heart failure, including ICDs and CRT. Sandy concludes by emphasizing the importance of comprehensive heart failure treatment that goes beyond symptomatic relief and addresses the underlying disease process. The video references several clinical trials and guidelines throughout the discussion.

Keywords

heart failure

ejection fraction

guideline-directed medical therapy

medications

dosing

monitoring

device therapy

comprehensive treatment