22409_HFMC_Managing Worsening Heart Failure With Reduced Ejection Fraction

In this educational initiative, the current definition and clinical impact of WHF will be described, and principles of management explained.

Worsening heart failure (WHF) is common and is associated with significant morbidity and mortality. Periods of clinical worsening are increasing recognized as a distinct phase in the history of HF. The definition of WHF has evolved to include both non-hospitalization and hospitalization events; furthermore, evidence demonstrates that outpatient escalation of oral diuretic therapy is not a benign event. Clinicians need to be aware of the data supporting these changes, and the increasing body of evidence illustrating poor outcomes for WHF patients in order to improve diagnosis and implement comprehensive treatment regardless of location of care. The foundation for treating worsening HF with reduced ejection fraction (HFrEF) is the rapid-sequence, simultaneous, and/or inhospital initiation of quadruple guideline-directed medical therapy (GDMT)—angiotensin receptor-neprilysin inhibitor, beta blocker, mineralocorticoid receptor antagonist, sodium-glucose cotransporter 2 inhibitor. Additional therapy with a soluble guanylate cyclase stimulator should be considered, on top of quadruple therapy, in patients with worsening HFrEF to reduce residual risk. In addition, early upfront use of a soluble guanylate cyclase stimulator should be considered among patients with WHF who have contraindications or intolerance to one or more of the quadruple medical therapies. Therefore, in this educational initiative, the current definition and clinical impact of WHF will be described, and principles of management explained. A panel discussion with WHF experts will provide practical guidance for diagnosing WHF, using GDMT in patients with worsening HFrEF, identifying patients for consideration of additional therapy, and strategies for utilizing additional medications in “real-world” practice.

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