Heart Failure

Consider switching beta-blocker therapy for your patient to a heart failure specific beta-blocker. Beta-blockers that improve clinical outcomes in HFrEF are bisoprolol, carvedilol, metoprolol succinate and nebivolol.

Consider introducing a SGLT2 inhibitor for your patient. SGLT2 inhibitors reduce cardiovascular mortality and hospitalisation for heart failure in patients with HFrEF, with or without type 2 diabetes. SGLT2 inhibitors are associated with ketoacidosis which can occur with or without accompanying hyperglycaemia. This risk is higher in patients with severe intercurrent illness or infection, those undergoing bowel preparation or surgery, restricted oral intake or dehydration.

Consider referral for a Medicines Review, Home Medicines Review (HMR) or Residential Medication Management Review (RMMR) for an assessment of complex heart failure treatment regimen.

Consider introducing a beta-blocker for your patient. Treatment of heart failure with HFrEF specific beta blocker has been shown to reduce the symptoms of heart failure, improves left ventricular ejection fraction, and reduces hospitalisation and mortality. Beta-blockers that improve clinical outcomes in HFrEF are bisoprolol, carvedilol, metoprolol succinate and nebivolol.

Consider introducing a mineralocorticoid receptor antagonists (MRA) for your patient. MRA that improve clinical outcomes in HFrEF are, eplerenone and low-dose spironolactone. Monitor blood pressure, eGFR and serum potassium one to two weeks after initiating an MRA or increasing the dose, then every four weeks for 12 weeks, at six months and then six-monthly thereafter or if clinically indicated.

Consider creating a GP management planfor your patient.

Consider referral to a cardiologist to evaluate need for alternative vasodilator. Low systolic blood pressure (<90 mmHg) and low renal function (eGFR <20mL/min) are contraindications for ACE inhibitors and ARBs.

Your patient might NOT be suitable for a beta-blocker. Do not start the beta-blocker therapy during a period of acute decompensation or if the patient has signs of congestion.

Your patient might NOT be suitable for a mineralocorticoid receptor antagonists (MRA). The risk of hyperkalaemia is particularly high in patients with renal impairment, older age and those taking a renin-angiotensin system inhibitor.

Your patient might NOT be suitable for a SGLT2 inhibitor. Low renal function, end-stage renal disease or rapidly declining kidney function are contraindications for SGLT2 inhibitors.

Consider referral for a Medicines Review. Home Medicines Review (HMR) or Residential Medication Management Review (RMMR) for an assessment of complex heart failure treatment regimen.

Consider creating a GP management planfor your patient.

Consider actions based on the patient’s comorbidities, such as diabetes, frailty, osteoporosis and renal function.