Pharmacy Clinical Pearl of the Day: First-line Treatment Options for Heart Disease

Clinical Pearl of the Day:

Heart failure disease first-line treatment options:

• ACE inhibitors/ARB or ARNI (Entresto) and Beta blockers plus aldosterone blockers (for Class II-IV heart failure with GFR>30ml, K+<5)
• SGLT-2 Inhibitor: If volume is overloaded add Loop diuretic

Explanation:

When it comes to heart failure treatment options, patients should be started on beta blockers, ACE inhibitors, ARBs, or ARNIs.

If the dosages are maxed out, patients do not tolerate, or patients do not benefit from these first-line options, then prescribers should be adding aldosterone blockers or SGLT-2 inhibitors

The goal is to reduce the symptoms, improve heart function, and increase ejection fraction.

Reference: 2021 Update to the 2017 ACC Expert Consensus Decision Pathway for Optimization of Heart Failure Treatment: Answers to 10 Pivotal Issues About Heart Failure With Reduced Ejection Fraction: A Report of the American College of Cardiology Solution Set Oversight Committee | Journal of the American College of Cardiology (jacc.org)