Quadruple Medical Therapy for Heart Failure: Medications Working Together to Provide the Best Care.

@article{Greene2021QuadrupleMT,
  title={Quadruple Medical Therapy for Heart Failure: Medications Working Together to Provide the Best Care.},
  author={Stephen J. Greene and Muhammad Shahzeb Khan},
  journal={Journal of the American College of Cardiology},
  year={2021},
  volume={77 11},
  pages={
          1408-1411
        }
}
  • S. Greene, M. Khan
  • Published 23 March 2021
  • Medicine
  • Journal of the American College of Cardiology
5 Citations
A multidisciplinary approach to heart failure care in the hospital: improving the patient journey.
TLDR
A summary of optimal inpatient management strategies for HF is provided, focusing on the multidisciplinary team of emergency medicine providers, admitting hospitalists, cardiovascular consultants, pharmacists, nurses, and social workers.
Clinical Prediction Models for Heart Failure Hospitalization in Type 2 Diabetes: A Systematic Review and Meta‐Analysis
TLDR
Most prediction models for hospitalization for heart failure in patients with type 2 diabetes have potential concerns with risk of bias or applicability, and uncertain external validity and clinical impact.
Mineralocorticoid receptor antagonists in diabetic kidney disease — mechanistic and therapeutic effects
TLDR
Clinical studies show that steroidal mineralocorticoid receptor antagonists (MRAs) have an anti-albuminuric effect in diabetic kidney disease, but the risk of hyperkalaemia associated with the use of these drugs has limited their use and evaluation for hard kidney and cardiovascular outcomes.
Simultaneous or rapid sequence initiation of medical therapies for heart failure: seeking to avoid the case of ‘too little, too late’
TLDR
The culture of care for HF with reduced ejection fraction does not include this same sense of therapeutic urgency, and despite robust clinical trial evidence and strong guideline recommendations, there remains a strong culture of hesitancy towards initiating and titrating lifesaving medications among eligible patients.
Another reason to embrace quadruple medical therapy for heart failure: medications enabling tolerance of each other
TLDR
Taken together, combination therapy with ARNI, beta-blocker, MRA, and SGLT2i is projected to provide a 73% relative reduction in 2-year mortality.

References

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Association of Optimal Implementation of Sodium-Glucose Cotransporter 2 Inhibitor Therapy With Outcome for Patients With Heart Failure.
TLDR
It is suggested that a substantial number of deaths in the United States could be prevented by optimal implementation of SGLT2-i therapy and this data support implementation of the current evidence into practice in a timely manner to achieve important public health benefits and to reduce the mortality burden of HFrEF.
Titration of Medical Therapy for Heart Failure With Reduced Ejection Fraction.
Medical Therapy for Heart Failure With Reduced Ejection Fraction: The CHAMP-HF Registry.
Reduced Risk of Hyperkalemia During Treatment of Heart Failure With Mineralocorticoid Receptor Antagonists by Use of Sacubitril/Valsartan Compared With Enalapril: A Secondary Analysis of the PARADIGM-HF Trial
TLDR
The data suggest that neprilysin inhibition attenuates the risk of hyperkalemia when MRAs are combined with other inhibitors of the renin-angiotensin-aldosterone system in patients with HF.