Heart Failure Management | ||||||
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Chronic Care
Clinic Follow Up Schedule* | |
Ejection Fraction | NT-proBNP (pg/ml) |
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* Once the heart rate reduction strategy has been achieved by following Figure 1 when the predominant physiology is HFrEF or Figure 2 when the physiology is HFpEF
If heart rate reduction is achieved and NT-proBNP >660 pg/ml adjust ACEi dose
If EF remains < 35% after 1 year on treatment consider ICD
Chronic Phase Medications | ||
Patients | Class Medication | Details |
All | ACE inhibitors | < 1 yr age captopril > 1 yr Enalapril/Ramipril |
EF < 45% | MRA β Blockers | Eplerenone/Aldactone Carvedilol/Bisoprolol* |
EF < 40% | HCN channel blocker | **Ivabridine |
EF < 40% & NTproBNP>660 pg/ml | ARNi | **Sacubritril/Valsartan |
EF < 30% | Antiplatelet | Asprin |
VT or Atrial Arrhythmia | Class III antiarrhythmic | Amiodarone ? ICD if VT |
* if diastolic pressure is low ** Reduce diuretics to prevent hypotension |
Undertake
- Annual CPET once older than 8 years. (the first 2 consecutive tests with similar results I dont understand)
- Cardiac MRI after 1 yr of maximum therapy to assess presence of LGE
Figure 1. HFrEF Physiology

Figure 2. HFpEF Physiology

Last Updated: April 2023