Rapid Clinical Updates: From Failure to Function: Closing the Gap Between Heart Failure Guidelines and Bedside Care-Slides

Pdf Summary

This presentation argues that heart failure care often fails at the transition from hospital to outpatient management, with many patients discharged on only one or two guideline-directed therapies and very few ever reaching target doses. The central message is that hospitalization is the best opportunity to start and titrate life-saving treatment.<br /><br />Key points include:<br />- The “four foundational therapies” for HFrEF are ARNI/ACEi/ARB, evidence-based beta-blockers, MRAs, and SGLT2 inhibitors.<br />- These should be started during admission when feasible, with STRONG-HF providing the model: initiate before discharge, aim for at least 50% target doses if tolerated, and reassess at 1, 2, 3, and 6 weeks with labs and dose adjustments.<br />- SGLT2 inhibitors can often be started early in the hospital and are useful across EF ranges, regardless of diabetes.<br />- Loop diuretic strategy should focus on effective decongestion rather than which loop is chosen; higher IV dosing may be needed, and add-on agents such as acetazolamide or thiazides can help if response is inadequate.<br />- Evidence for newer therapies broadens management across EF: finerenone in HFmrEF/HFpEF, GLP-1/GIP or GLP-1 agents in obesity-related HFpEF, and vericiguat for worsening HFrEF.<br />- Iron deficiency treatment improves symptoms and functional status, though mortality benefit remains uncertain.<br />- Cardiac amyloidosis should be considered more often, especially in HFpEF with disproportionate LVH or suggestive clinical features.<br />- Discharge planning must include a medication bundle, diuretic plan, early follow-up, lab monitoring, patient education, and clear ownership of titration.<br /><br />Overall, the talk emphasizes a practical, structured approach to closing the gap between HF guidelines and bedside care.

Meta Tag

Concept Heart Failure

Concept Guideline-Directed Medical Therapy

Concept Medication Reconciliation

Concept Hospital Discharge

Concept Four Foundational Therapies

Keywords

heart failure

HFrEF

guideline-directed therapy

hospital discharge

STRONG-HF

SGLT2 inhibitors

loop diuretics

HFpEF

cardiac amyloidosis

treatment titration

Heart Failure

Guideline-Directed Medical Therapy

Medication Reconciliation

Hospital Discharge

Four Foundational Therapies