A Novel Approach to Medical Management of Heart Failure With Reduced Ejection Fraction.

摘要: The advent of newly available medical therapies for heart failure with reduced ejection fraction (HFrEF) has resulted in many potential therapeutic combinations, increasing treatment complexity. Publication expert consensus guidelines and initiatives aimed to improve implementation emphasized sequential stepwise initiation titration therapy, which is labour intensive. Data taken from registries show suboptimal use medications, prolonged times, consequently little change dose intensity, all indicate inertia. Recently published evidence indicates that 4 medication classes-renin-angiotensin-neprilysin inhibitors, β-blockers, mineralocorticoid antagonists, sodium-glucose cotransporter inhibitors-which we refer as Foundational Therapy, confer rapid robust reduction both morbidity mortality most patients HFrEF they work additive fashion. Additional may be observed following addition several personalized specific subgroups patients. In this review, discuss mechanisms action these propose a framework their implementation, based on principles. These include the critical importance Therapies followed by target doses, emphasis multiple simultaneous drug changes each patient encounter, attention patient-specific factors choice class, leveraging inpatient care, entire health care team, alternative (ie, virtual visits) modes care. We have incorporated principles into Cluster Scheme designed facilitate timely optimal HFrEF.