The sodium-glucose cotransporter 2 (SGLT2) inhibitors, dapagliflozin and empagliflozin, are added to therapy with an ACE inhibitor–ARNI, a beta-blocker, and an MRA to reduce the risk for cardiovascular (CV) death and worsening HF in patients with HFrEF. In general, dapagliflozin or empagliflozin are recommended for all patients with HFrEF who have already been treated with an ACE inhibitor–ARNI, a beta-blocker, and an MRA, regardless of whether they have diabetes.
An angiotensin receptor blocker (ARB) is recommended to reduce the risk for HF hospitalization and CV death in symptomatic patients who cannot tolerate an ACE inhibitor or an ARNI. These patients should also receive a beta-blocker and an MRA.
According to ESC guidelines, the l f current inhibitor ivabradine should be started in symptomatic patients who continue to have LVEF ≤ 35% in sinus rhythm and a resting heart rate ≥ 70 beats/min. Despite treatment with the triad described above. This agent may reduce the risk for HF hospitalization and CV death.
Medscape © 2022 WebMD, LLC
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Marco Guazzi. Skill Checkup: A 71-Year-Old Man With History of Chronic Heart Failure Presents With Dyspnea, Rales, and Ankle Swelling - Medscape - May 02, 2022.