As a clinical pharmacy specialist, cardiologists will ask you for your recommendations on which beta-blockers are better, carvedilol or metoprolol in patients with heart failure and diabetes . There is tantalizing evidence that carvedilol MIGHT be better. But the truth is not so clear. The first head-to-head comparison sugges…
Read moreAs a clinical pharmacist, you will need to ensure appropriate use of SGLT2 inhibitors (empagliflozin, etc), as more hospitals add these medications to formulary. It’s partly because guidelines for heart failure with reduced ejection fraction (HFrEF) now recommend “quad therapy” adding an SGLT2 inhibitor (SGLT2i) to triple therapy , regardless of diabetes. …
Read moreAs a nutrition support pharmacist, you should advise on the best diet for your patients with heart failure. Previously, the focus on preventing and treating heart failure was to restrict excess sodium intake in order to prevent excess fluid load. While sodium control is still important, macronutrient nutrition may be more important in prevention than previously thou…
Read moreAs a cardiovascular pharmacist, you will hear lots of buzz about Entresto , a new drug for systolic heart failure. It's the first "angiotensin receptor neprilysin inhibitor" (ARNI) and combines valsartan with sacubitril. Sacubitril works by inhibiting the enzyme neprilysin. This increases sodium loss and vasodilation and enhances ARB efficacy (see figur…
Read moreGetting POTASSIUM levels right for patients with heart failure can be a balancing act due to changes in medications, diet and kidney function. Hypokalemia and hyperkalemia are common electrolyte disorders caused by changes in potassium intake, altered excretion, or transcellular shifts. Diuretic use and gastrointestinal losses are common causes of hypokalemia, while…
Read moreHow to treat "DIASTOLIC" heart failure or heart failure with a PRESERVED ejection fraction (HFpEF)? Over HALF of heart failure patients have this type, which is due to a stiff left ventricle that can't adequately fill. This is different from "SYSTOLIC" heart failure or heart failure with a REDUCED ejection fraction (HFrEF). These patients have…
Read moreRecently, more patients withOUT diabetes will use SGLT2 inhibitors ( Invokana, Forxiga, etc ) for heart failure or kidney disease . That's because growing evidence suggests these medications may improve outcomes when added to standard therapy. In heart failure with reduced ejection fraction (HFrEF), adding Jardiance (empagliflozin) over 16 months prevents hospi…
Read moreLess than half of eligible heart failure patients take an aldosterone antagonist (spironolactone, eplerenone). Help close the gap for patients with systolic heart failure. Now called heart failure with reduced ejection fraction (HFrEF). Think of an angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) , beta-blocker (BB), and aldoste…
Read moreOverview ã…¡ Heart failure typically classified by New York Heart Association (NYHA) I-IV functional classification or American College of Cardiology Foundation/American Heart Association (ACCF/AHA) A-D staging ( see table 1 ) . Heart failure with reduced ejection fraction (HFrEF) or systolic heart failure results in decreased heart pump function (left ventricular ejec…
Read moreHEART FAILURE is a frequent and often fatal complication of type 2 diabetes and there will be more focus on how this affects medication choices. Consider whether your patient also has heart failure when evaluating diabetes medications, since some may help or harm. Medications with potential benefit Continue to recommend metformin first, it's linked to l…
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