Annals for Hospitalists Inpatient Notes - Clinical Pearls—Stopping, Starting, and Optimizing Guideline-Directed Medical Therapy in Patients Hospitalized for Heart Failure With Reduced Ejection Fraction
Authors: Stephen J. Greene, Gregg C. Fonarow, Javed Butler
Journal: Annals of Internal Medicine (2022)

Web ExclusivesJanuary 2022Annals for Hospitalists Inpatient Notes - Clinical Pearls—Stopping, Starting, and Optimizing Guideline-Directed Medical Therapy in Patients Hospitalized for Heart Failure With Reduced Ejection FractionStephen J. Greene, MD, Gregg C. Fonarow, MD, and Javed Butler, MD, MPH, MBAStephen J. Greene, MDDuke Clinical Research Institute and Division of Cardiology, Duke University School of Medicine, Durham, North Carolina (S.J.G.)Search for more papers by this author, Gregg C. Fonarow, MDDivision of Cardiology, Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, California (G.C.F.)Search for more papers by this author, and Javed Butler, MD, MPH, MBADepartment of Medicine, University of Mississippi Medical Center, Jackson, Mississippi (J.B.).Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M21-4558 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail A 68-year-old woman presents to the emergency department with 1 week of worsening dyspnea on exertion, orthopnea, and leg swelling. She has a history of ischemic cardiomyopathy and heart failure with reduced ejection fraction (HFrEF), with an ejection fraction of 25% on her most recent echocardiogram this past year. Her medications for HFrEF before admission include 10 mg of lisinopril daily, 6.25 mg of carvedilol twice daily, and 40 mg of furosemide twice daily. On physical examination, she is in no acute distress, but her examination is notable for bibasilar crackles, jugular venous distention, and lower extremity edema. Vital signs ...References1. McDonagh TA, Metra M, Adamo M, et al; ESC Scientific Document Group. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42:3599-3726. [PMID: 34447992] doi:10.1093/eurheartj/ehab368 CrossrefMedlineGoogle Scholar2. Bassi NS, Ziaeian B, Yancy CW, et al. Association of optimal implementation of sodium-glucose cotransporter 2 inhibitor therapy with outcome for patients with heart failure. JAMA Cardiol. 2020;5:948-951. [PMID: 32374344] doi:10.1001/jamacardio.2020.0898 CrossrefMedlineGoogle Scholar3. Vaduganathan M, Claggett BL, Jhund PS, et al. Estimating lifetime benefits of comprehensive disease-modifying pharmacological therapies in patients with heart failure with reduced ejection fraction: a comparative analysis of three randomised controlled trials. Lancet. 2020;396:121-128. [PMID: 32446323] doi:10.1016/S0140-6736(20)30748-0 CrossrefMedlineGoogle Scholar4. Greene SJ, Triana TS, Ionescu-Ittu R, et al. Patients hospitalized for de novo versus worsening chronic heart failure in the United States [Letter]. J Am Coll Cardiol. 2021;77:1023-1025. [PMID: 33602461] doi:10.1016/j.jacc.2020.12.026 CrossrefMedlineGoogle Scholar5. Greene SJ, Butler J, Fonarow GC. Simultaneous or rapid sequence initiation of quadruple medical therapy for heart failure-optimizing therapy with the need for speed. JAMA Cardiol. 2021;6:743-744. [PMID: 33787823] doi:10.1001/jamacardio.2021.0496 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Duke Clinical Research Institute and Division of Cardiology, Duke University School of Medicine, Durham, North Carolina (S.J.G.)Division of Cardiology, Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, California (G.C.F.)Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi (J.B.).Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M21-4558.Corresponding Author: Javed Butler, MD, MPH, MBA, University of Mississippi Medical Center, Department of Medicine (L650), 2500 North State Street, Jackson, MS 39216; e-mail, [email protected]edu. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAnnals for Hospitalists - January 2022 Megan Mack , Matthew Luzum , and David H. Wesorick Metrics January 2022Volume 175, Issue 1Page: HO2-HO3KeywordsHeart failureHospitalizations ePublished: 18 January 2022 Issue Published: January 2022 Copyright & PermissionsCopyright © 2022 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...