¿Cómo? Consejos prácticos

¿Cómo? Consejos prácticos
Dr. José Ramón González-Juanatey
Hospital Clínico Universitario de Santiago de Compostela

Título de la ponencia Nombre ponente
¿Cómo? Consejos prácticos José Ramón González-Juanatey
HOSPITAL ADMISSION HOSPITAL
DISCHARGE
EARLY
POST-
DISCHARGE
PHASE
LATE
POST-DISCHARGE
PHASE
Decongestion/Low CO GDMT Initiation GDMT Optimization
TRANSITION PHASE
TRANSITION TO ORAL THERAPIES
HF Patient Pathway. The Challenge

Drugs recommended in all patients with heart failure with
reduced ejection fraction
Recommendations Classa Levelb
ACE-I is recommended for patients with HFrEF to reduce the risk of HF hospitilization and death.
I A
Beta-blocker is recommended for patients with stable HFrEF to reduce the risk of HF hospitalization
and death. I A
MRA is recommended for patients with HFrEF to reduce the risk of HF hospitalization and death.
I A
Dapagliflozin or empagliflozin are recommended for patients with HFrEF to reduce the risk of HF
hospitalization and death. I A
Sacubitril/valsartan is recommended as a replacement for an ACE-I in patients with HFrEF to reduce
the risk of HF hospitalization and death I B
New!
McDonagh T & Metra M et al. EHJ & EJHF 2021.
aClass of recommendation. bLevel of evidence
The 2021 ESC / HFA Guidelines on the diagnosis & treatment of heart failure

Strategic phenotypic overview
of the management of heart
failure with reduced ejection
fraction
Class I = Green.
Class Iia = Yellow.
The Figure shows management options.
See the specific tables for those with
Class IIb recommendations.
McDonagh T & Metra M et al. EHJ & EJHF 2021.

• Single dose, no titration
• Can be started in hospital or in the community
• Early beneficial effect (<28 days)
• Outstanding tolerability
• Low effect on Blood Presure and No effect on HR
• Preserves rather tan worsens renal function
(do we need to check blood chemistry?)
• Reduces the risk of hyperkalaemia with MRAs
(another concept: agents started earlier can enhance the safety of drugs
started later?)
Use of SGLT2 inhibitor early or even first?
The practicalities of drug treatment in Heart Failure

Effects of dapagliflozin in DAPA-HF according to backgroung HF therapy
Dapagliflozin Placebo
Docherty KF. Eur Heart J 2020

Simultaneous or Rapid
Sequence Initiation of
Medical Therapies for HF:
Seeking to Avoid the Case
of “Too Little, Too Late”
Khan MS, et al. Eur J Heart Fail 2021.

The transition from
hospital to ambulatory care
Verma S, Anker SD, Butler J & Bhatt DL.
ESC-HF 2020

The efficacy and safety of
dapagliflozin were consistent
across the diuretic subgroups
examined in DAPA-HF.
Dapagliflozin and Diuretic Use in Patients with HFrEF in DAPA-HF
Jackson AM, et al. Circulation 2020; 142: 1040-1054.

WRF: worsening renal function
IRF: improved renal function
Group A: on S/V in which Empa is
initiated.
Group B: on Empa in which S/V is
initiated
Group C: naive patients in which
S/V and Empa were initiated
simultaneously
The practicalities of drug treatment in Heart Failure .
Treatment Strategy
De la Espriella R et al . ESC Heart Failure 2020

< + 30% HFH at 15 y 30 days:
8% at 15 days and 15% at 30 days

• Single dose, no titration
• Can be started in hospital or in the community
• Early beneficial effect (<28 days)
• Outstanding tolerability
• Low effect on Blood Presure and No effect on HR
• Preserves rather tan worsens renal function
(do we need to check blood chemistry?)
• Reduces the risk of hyperkalaemia with MRAs
(another concept: agents started earlier can enhance the safety of drugs
started later?)
Use of SGLT2 inhibitor early or even first
The practicalities of drug treatment in Heart Failure

¿Cómo? Consejos prácticos

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