Top 5 strategies to ⬇️ ☠️ and re-🏨 in HFrEF
1. In-🏨 ARNI+BB+MRA+SGLT2i
2. In-🏨 ARNI+BB+MRA+SGLT2i
3. In-🏨 ARNI+BB+MRA+SGLT2i
4. In-🏨 ARNI+BB+MRA+SGLT2i
5. In-🏨 ARNI+BB+MRA+SGLT2i
Gregg Fonarow MD
11.4K posts
- HFrEF Within 30-60 days of Rx ✅ARNI ⤵️CV☠️HF🏨 42% ✅BB ⤵️☠️25% ✅MRA ⤵️CV☠️HF🏨 37% ✅SGLT2i ⤵️☠️HF🏨urgent visit 58% Unnecessary delays in Rx result in significant harms @SJGreene_md @JavedButler1 @robmentz @DLBHATTMD @MKIttlesonMD @jesse8850 #AHA21
- HFrEF ARNI+BB+MRA+SGLT2i Extend median survival by 7-11 YEARS Self-pay cash price for all 4 💊 $121 per month Available today
- 2022 ACC/AHA HF Guidelines are out ARNI+BB+MRA+SGLT2i all Class I for HFrEF From @JACCJournals jacc.org/doi/10.1016/j.… @paheidenreich @BiykemB @NMHheartdoc @ACCinTouch @American_Heart @HFSA
- Compared to ACEI+BB, treatment with disease-modifying quadruple ARNI+BB+MRA+SGLTi in eligible patients with HFrEF ➡️ additional years of overall survival 55 yo: 6.3 years 65 yo: 4.4 years 70 yo: 3.9 years 75 yo: 3.1 years 80 yo: 1.4 years Not days, weeks, or months… Years!
- HF Won’t Wait! Delay ARNI ➡️ 42% ⬆️ risk CV☠️/HF🏨 Delay BB ➡️ 25% ⬆️ risk ☠️ Delay MRA ➡️ 37% ⬆️ risk CV☠️/HF🏨 Delay SGLTi ➡️ 58% ⬆️ risk CV☠️/HF🏨/ER Unnecessary delays in any one or more of foundational GDMT ➡️ preventable ☠️/🏨 Urgency and intensity needed
- HFrEF ↘️↘️↘️median survival 12-18 years GDMT ↗️↗️↗️ median survival: ✅ ARNI 2-3 yrs (1-2 yrs vs ACEI or ARB) ✅ BB 3-4 yrs ✅ MRA 2-3 yrs ✅ SGLTi 1-2 yrs Clinical benefits non-overlapping, incremental, additive Quadruple >>>triple>>>double Fast >>>>slow Simultaneously 🏆
- New quadruple Rx for HFrEF: ARNI, BB, MRA, SGLT2i. Cumulative risk reduction in all-cause mortality, 74% relative, 26% absolute, NNT 4 in just 2 years. Plus ⬆️ health status, ⬇️ worsening, and ⬇️ hospitalizations. @HFSA @AAHFN @NMHheartdoc @JavedButler1 @JJheart_doc @rcstarling
- HFrEF ↘️↘️↘️median survival 12-18 years GDMT ↗️↗️↗️ median survival: ✅ ARNI 2-3 yrs (1-2 yrs vs ACEI or ARB) ✅ BB 3-4 yrs ✅ MRA 2-3 yrs ✅ SGL2i 1-2 yrs Clinical benefits non-overlapping, incremental, additive Quadruple >>>triple>>>double Fast >>>>slow Simultaneously!
- Still the Top 5 strategies to ⬇️ ☠️ and re-🏨 in HFrEF 1. In-🏨 ARNI+BB+MRA+SGLT2i 2. In-🏨 ARNI+BB+MRA+SGLT2i 3. In-🏨 ARNI+BB+MRA+SGLT2i 4. In-🏨 ARNI+BB+MRA+SGLT2i 5. In-🏨 ARNI+BB+MRA+SGLT2i
- GDMT for HFrEF ✅ Quadruple, rather than double/triple ✅ Simultaneously, rather than sequentially ✅ Today, rather than someday ✅ Urgently, rather than lackadaisically ✅ Expeditiously, rather than delayed ✅ Now, rather than later ✅ Systematically rather than haphazardly
- Comparative efficacy of HFrEF medications for relative risk reduction in all-cause mortality as function of baseline risk by trial ARNI+BB+MRA+SGLT2i superior magnitude of benefit @paheidenreich @MKIttlesonMD @NMHheartdoc @JavedButler1 @mvaduganathan @_adevore @HFSA @DLBHATTMD
- 🏨 with HFrEF Only one at a time Go slow Defer to outpatient Be cautious What is the worst that can happen? Delay ARNI ➡️ 42% ⬆️ risk CV☠️/HF🏨 Delay BB ➡️ 25% ⬆️ risk ☠️ Delay MRA ➡️ 37% ⬆️ risk CV☠️/HF🏨 Delay SGLTi ➡️ 58% ⬆️ risk CV☠️/HF🏨/ER Urgency needed!
- A review of current evidence regarding the epidemiology, pathophysiology, presentation, diagnosis and treatment of HFpEF Heart Failure With Preserved Ejection Fraction ja.ma/3JtanrY via @JAMA_current part of @JAMANetwork
