D. Suryaprabha
Chief Clinical Pharmacist and Assistant Manager – Clinical Research, Kauvery Hospitals, India
*Correspondence: +91 98414 86267;suryaprabha@kauveryhospital.com
Guideline-directed drug treatment for heart failure
Heart failure remains a leading cause of morbidity and mortality globally.
This guest editorial provides recommendations based on contemporary evidence for the treatment of these patients.
The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve the quality of care and align with patients’ interests. Guideline-directed medical therapies at recommended doses are underutilised in patients with Heart failure with reduced ejection fraction (HFrEF).
Many patients with heart failure either do not receive guideline-directed medical therapies or receive doses considerably below the guideline-recommended doses. Despite significant advances in therapies and prevention, their mortality and morbidity are still high and their quality of life poor.
The prevalence, incidence, mortality and morbidity rates reported show geographic variations, depending on the different etiologies and clinical characteristics observed among patients with HF. Medication adherence is very poor and the tolerance of to guideline-based medication is low for Indian patients. There is poor awareness about the condition and its treatment.
Inequitable access to healthcare delivery continues to be a key issue with the Indian healthcare system.
Medication Summary Goal
The goals of pharmacotherapy for heart failure are to reduce morbidity and to prevent complications.
The management of HF patients includes four major pillars of pharmacological treatment. The ideal patient will be managed with ARNi, beta-blockers, MRAs, and an SGLT2 inhibitor.
- Angiotensin receptor/neprilysin inhibitor (ARNI) e.g. Sacubitril/valsartan or Angiotensin-converting enzyme inhibitors (ACEIs) or Angiotensin II receptor blockers (ARBs)
- Cardio-selective beta-blockers
- Aldosterone antagonist e.g. Spironolactone, eplerenone
- Sodium-glucose cotransporter-2 (SGLT2) inhibitor
These four drug classes have been studied and have shown benefit benefits for long-term management of HFrEF.
Most of the patient patients receive only one out of four guideline directedguideline-directed drugs!!!
Drugs that can exacerbate heart failure should be avoided, such as nonsteroidal anti-inflammatory drugs (NSAIDs), calcium channel blockers (CCBs), and most antiarrhythmic drugs (except class III).
The venerable and highly economical economical drug Digoxin, unfortunately , has no more a place in the evidence based evidence-based practice practice of management of heart failure. It may have a limited role in HF associated with Atrial Fibrillation Public healthcare infrastructure for cardiology is inefficient and inadequate to meet the increasing burden of heart failure in India.
There is a compelling need for the initiation of first-line, guideline-directed medical therapy, with HFrEF, particularly for the low-income and middle-income patients
Strategies include the establishment of programmatic approaches to the management of heart failure, targeted education for physicians to strengthen evidence-based practices, and increased patient awareness of the importance of guideline-directed medical therapy at appropriate.
Reference:
Heidenreich, PA et al. AHA/ACC/HFSA guideline for the management of heart failure: A report of the American college of cardiology/American heart association joint committee on clinical practice guidelines. 2022.
![D. Suryaprabha](https://www.kauveryhospital.com/images/nightingale/v1i4/D.%20Suryaprabha.jpg)
D. Suryaprabha
Senior Executive-Clinical Research
Nightingale Journals
- Message from Dr. Manivannan Selvaraj, Founder and Managing Director, Kauvery Hospitals
- EDITORIAL
- Editorial Board
- Voices from the field!
- Junior nurses in Kauvery Hospital on the frontline against the COVID-19 pandemic
- Challenges in nursing care in achieving a successful outcome to a Liver Transplant on a 2-year old child with life threatening genetic condition
- Nursing management of a multi-organ transplant (Liver and Kidney) on an adolescent
- Successful discharge of a four year old baby with life threatening gas gangrene and compartment syndrome
- The revolutionary effect of a nursing-driven initiative to reduce ICU re-admissions
- Nephrotic syndrome: A case report
- Nursing Care of Patient with Thoracic Endo vascular Aortic Repair (TEVAR)
- Efficient Nursing Care equals Early Recovery
- Umbilical Cord Blood Banking is a lifesaver for your family, “Create one life, save another”: A review
- Challenges associated with wearing gloves
- Certificate Course on Infection Control 2022
- The ANEI Young Leader Award, 2022, comes to Kauvery Hospitals!
- The AHPI Nursing Excellence Award 2022, comes to Kauvery Hospital, Tennur
- Editorial
- Editorial Board
- Caring is the Essence of Nursing
- To be patient and calm! Why I Love Working as an Emergency Room Nurse
- Infective Endocarditis
- Infective Endocarditis
- Patent Ductus Arteriosus
- HOSPITalk 2023 – Clinical Governance
- Cardiac healthy diet
- Healthy diet for people working night shifts
- Chimeric antigen receptor (car) T cell therapy
- Human papillomavirus (HPV) vaccine
- Kauvery Hospital Journey on Winning National Level CII QC Competition Against the Industrial Sectors
- செவிலியர்கள் தின வாழ்த்து கவிதை
- அன்பு காவேரி
- Hepatology for nurses
- Role of Physiotherapy in Traumatic Brain Injury: A case report
- My experience at Kauvery Hospital, Salem
- Editorial
- Editorial Board
- Benign Paroxysmal Positional Vertigo (BPPV): A Case Series
- Nutrition for Nurses
- Cardiovascular effects of sodium – glucose co-transporter- 2 inhibitor, Glucagon-like Peptide-1 Receptor Agonists and Dipeptidyl-peptidase 4 inhibitors
- Brief Guide on Food Safety Standards to be Adopted Summer in South India
- Kauvery Hospital: Pioneering the Future of Healthcare with IoT, Wins Healthcare Asia Awards.
- மருத்துவர்கள் தின வாழ்த்து கவிதை
- காவேரியனின் தன்னம்பிக்கை
- வெற்றியின் பாதை
- Editorial
- Editorial Board
- A six-year-old girl gets a Permanent Pacemaker implanted!
- Cardio Renal Amyloidosis (Non-Secretory Myeloma)
- Deep Vein Thrombosis, treated with Angiojet Percutaneous Mechanical Thrombectomy (PMT): A Case Report
- Emergency CABG in Acute MI
- Meatotomy
- Septic Shock with Multiple Organ Dysfunction Syndrome: A Case Report
- Stab Injury: A Case Report
- The Journey of Dialysis Unit at Hosur
- The measure of life is not its duration but its donation
- Innovation at the frontline of Nursing: A Review
- A case study on hydatid cyst
- Untold History of British Scientist: Contributed to the Discovery of DNA
- Neurology for Nurses
- Poem
- மருத்துவாலயம்
- EDITORIAL
- Editorial Board
- Biological or circadian clock
- A novel direct thrombin inhibitor from tick salivary transcriptoms: A review
- Nursing Care of a Patient with Coarctation of aorta (COA)
- Nursing care of patient with aortic dissection
- Wireless moonlight: An ultra-short case study
- Acute liver failure: A case report
- We nurses hand-hold a patient on a long walk down a dark COVID road
- Effectiveness of segmental breathing and active cycle of breathing technique in the management of dyspnoea among covid-19 patients
- EDITORIAL
- Editorial Board
- I am a proud to be a Liver Transplant Nurse!
- Head Injury: A case report
- Postpartum/Peripartum Cardiomyopathy
- Nursing Care of Patient with Myocardial Infarction
- Nursing challenges faced in care of patient with Blunt Injury Abdomen
- Salicylate poisoning
- Vascular Access Management (VAM) training program for nurses
- Therapeutic Nutrition among Critical care patients
- Diagnostic Image
- EDITORIAL
- Editorial Board
- Guideline-directed drug treatment for heart failure
- Dilated cardiomyopathy
- IV Proton Pump Inhibitors (PPIs): What are the true indications?
- Role of physiotherapy in GBS patients during hospitalization:A case presentation
- Pulmonary Thromboembolism
- Paraquat poisoning, an emerging problem, a challenging outcome
- Achievements of today are the stepping stones for success tomorrow!
- Diagnostic Image
- Chronic obstructive pulmonary disease: A case report
- EDITORIAL
- Editorial Board
- The Good Nurse
- Success story of a patient with Haemangioma
- Role of physiotherapy in Bell’s Palsy at outpatient department
- Arrhythmogenic Right Ventricular Dysplasia: A Cardiomyopathy
- Systemic Lupus Erythematosus (SLE)
- Teamwork makes a Dreamwork
- Cholecysto Cutabeous Fistula, an emerging problem: a challenging outcome
- Adhesive small bowel obstruction: Nutrition care process
- Diagnostic Image
- Editorial
- Editorial Board
- Quality improvement project to reduce the incidence of ventilator-associated pneumonia
- Rare disease, desired outcome
- Management of patients with acute myocardial infarction with ischemic stroke
- Left mediastinal tumor excision
- Esophageal varices grade III: A case report
- TB meningitis: A case report
- Nutrition care process for Sigmoid Diverticulitis
- Nutritional management of patient who underwent emergency laparotomy and GIST
- Nutritional management of gestational diabetes mellitus
- Nutrition and drug interaction
- மக்களின் நம்பிக்கை!
- காவேரித்தாய் – 2
- ஊசியின் மகத்துவம்
- Editorial
- Editorial Board
- Resilient and Empowered: The Unstoppable Force of Women’s Spirit
- “Global Perspectives on Patient Safety: A Recap of the International Patient Safety Conference – 13th to 14th Feb 2023”
- Acute Pancreatitis: the nutrition care process
- Role of diet in mitral valve replacement: A case presentation
- Our colleague’s SVT (Supra Ventricular Tachycardia)!
- Acute respiratory distress syndrome: A case report
- To prevent the negative impact of Inj. Amphotericin among Mucormycosis patients
- Diagnostic Image
- Effective Adherence of Checklist through Digitalisation
- Nephrology for Nurses
- “உயிரைக்காக்கும் உயரியதானம்”
- மக்களின் நம்பிக்கை
- Editorial
- Editorial Board
- SVT (Supra Ventricular Tachycardia)
- Tender loving care of patient with DVT after IVF (in vitro fertilization)
- ASD Surgical Closure
- Quality improvement project to reduce the risk of cross infection from wall mounted suction apparatus
- Quality Improvement Project on Crash Cart Management with numbered seal
- Log the Indian Millets
- Crystal your body by dint of seven Crystal Seeds!
- Role of Glucagon
- Educative Image: Department of Orthopaedics
- Nephrology for Nurses! – Part 2
- EDITORIAL
- Editorial Board
- இதயநகரத்தின் செவிலியர்கள் தின வாழ்த்து
- My experience as a patient
- A study on Anidulafungin therapy in oncology patients in a tertiary care hospitals
- A case study on Heart Transplantation
- Your Physiotherapist’s talks! Know your Moves
- Impact of air pollution on human health
- 4th QOK Group Level Competition 2023
- 7th International conference of CAHO
- செவிலியர் எனும் தாய்
- HEPATOLOGY FOR NURSES
- Editorial
- Editorial Board
- Unknown etiology, thoughtful management, gratifying outcomes!
- Antiphospholipid Syndrome(APLS) in a man
- World Organ Donation Day Celebration at Kauvery Hospital, Hosur
- Approach to cardiac arrest
- Cardiac Tissue Viability Study
- Dietary management after Mitral Valve Replacement
- Clipping of a Cerebral Aneurysm at Nellai
- Care of Chronic Suppurative Otitis Media (CSOM)
- Management of a Neck Injury
- Pituitary Macroadenoma: A case report
- Superior mesenteric artery thrombosis
- Pharmacists: The Silent Heroes of the Health Care System
- Educative Image
- Poem
- A battle to win a baby
- 5S Sustenance Level-Up for Salem, Hosur and ECB Units
- Editorial
- Editorial Board
- Attempted Hanging: A case series
- Sub Arachnoid Hemorrhage due to Cerebral Aneurysm
- Acute Pulmonary Thromboembolism with Systemic Lupus Erythematous
- Down Syndrome with Severe Pulmonary Stenosis
- Bentalls Procedure
- Glycogen Storage Disease (GSD)
- Nursing Care of Patient with Penetrating Chest Injury (Left Chest Wall)
- A child with Acute Inflammatory Demyelinating Polyradiculoneuropathy (AIDP) – Guillian- Barre Syndrome (GBS)
- Periampulatory carcinoma (Whipple’s procedure)
- Assisted delivery with Forceps Extraction
- Thrilling Moment on a Successful transportation of the cadaver donor liver to its recipient
- Editorial
- Transcatheter Aortic Valve Implantation (TAVI)
- Cautery Burns: A Clinical Audit
- Automatic Implantable Cardioverter Defibrillator (AICD)
- Thymectomy
- Deep Vein Thrombosis: A case report
- Mesentric Neoplasm
- QT Syndrome
- Healthy diet, affordable for all – Fuel for the Future
- Personalizing 5-FU Treatment in Head and Neck Cancer: A TDM Pilot Study
- Rapid Review of CNE -Nursing Challenges in Coronary Artery Diseases
- Preconference Workshop on International patient safety Goals (IPSG)
- Editorial
- Cerebral malaria: Management with artesunate
- Hypertrophic cardiomyopathy: A case report
- Incredible challenges and outcomes: A case report
- Prevention of extravasation in Oncology unit
- Management of germ cell tumors: A review
- Monocytes: The mysterious cell on the CBC
- Efficacy of individualized use of a multisensory integrative environment on engagement: In children with sensory modulation disorder
- Dietary guidelines and food safety: For immuno-suppressed/compromised patients
- Nutritional management: For a patient with triple vessel disease
- இயன்முறை மருத்துவமும் மறுவாழ்வும்
- உயிர் காக்கும் தானம்
- மாற்றத்தை விதைக்கும் திறனாளிகள்
- EDITORIAL
- EDITORIAL BOARD
- CEREBRAL MALARIA: A CASE REPORT
- CEFEPIME – TAZOBACTUM – INDUCED FLUID – FILLED BLISTERS (BULLOUS LESIONS): A CASE REPORT
- BLOOD TRANSFUSION REACTIONS: AN OVERVIEW
- EFFECTIVENESS OF REHABILITATIVE APPROACH-BASED MANAGEMENT FOR CHILDREN WITH JAPANESE ENCEPHALITIS (JE)
- THE EFFECT OF NUTRITIONAL COMPOSITION ON THE GLYCEMIC INDEX AND GLYCEMIC LOAD VALUES
- KCHS PRATIDHI RISES TO THE CHALLENGE: A TRIUMPH AT THE NATIONAL QC CONVENTION
- JOURNAL SCAN FOR THE CLINICAL PHARMACIST: A REVIEW OF 10 RECENT PAPERS OF IMMEDIATE CLINICAL SIGNIFICANCE, HARVESTED FROM THE JANUARY 2024 EDITION OF THE MEDICINE, ELSEVIER
- காவேரித்தாய் – 4
- EDITORIAL
- INSTRUCTIONS TO AUTHORS
- AORTIC ANEURYSM WITH PARAVERTEBRAL COLLECTION
- DEEP VEIN THROMBOSIS AT RIGHT UPPER LIMB: A CASE REPORT
- ENTEROVIRUS ASSOCIATED MENINGOENCEPHALITIS: A CASE REPORT
- CONGENITAL HEART DISEASE (ASD – OS): A CASE REPORT
- FUNCTIONAL SHORT GUT SYNDROME: A CASE CAPSULE
- PERI-OPERATIVE CARE DURING CYTOREDUCTION SURGERY (CRS) WITH HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY (HIPEC): KAUVERY EXPERIENCE.
- A CASE REPORT: MYELOPROLIFERATIVE NEOPLASMS (MPNS) WITH CABG
- OVERVIEW OF BREAST FEEDING: A REVIEW
- PITUITARY MACRO ADENOMA-TRANS-NASAL TRANS-SPHENOIDAL ENDOSCOPIC EXCISION
- JOURNAL SCAN: A CASE REVIEW OF IMMEDIATE CLINICAL SIGNIFICANCE, HARVESTED FROM MAJOR INTERNATIONAL JOURNAL
- தயக்கம் தவிர்