Skill Checkup: A 62-Year-Old Black Male With History of Hypertension Experiences Mild Cognitive Impairment and Breathlessness

Jeffrey J. Hsu, MD


March 13, 2023

In addition to GDMT, diuretics are recommended in patients with HFrEF with symptoms of congestion. According to guidelines from the European Society of Cardiology, diuretics are prescribed to improve HF symptoms and exercise capacity while reducing the risk for HF hospitalizations. Current GDMT should not be adjusted.

Thiazolidinediones are indicated for patients with type 2 diabetes, which this patient does not have. However, it is important to note that they should be avoided in patients with type 2 diabetes and reduced left ventricular ejection fraction. This recommendation is based on the results of randomized controlled trials of patients with type 2 diabetes, showing thiazolidinediones were associated with fluid retention and increased rates of HF among patients who were largely free of symptomatic HF at baseline. In addition, increased rates of HF hospitalization, increased rates of fluid-related events, and greater requirement of HF therapy have been observed in smaller trials of patients with HF treated with thiazolidinediones.

Editor's Note: Skill Checkups are wholly fictional or fictionalized clinical scenarios intended to provide evidence-based educational takeaways.

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