In this RCT, over 1000 patients who were not on full doses of CHF medication were randomised to early and rapid up-titration of neurohormonal blockade (beta-blockers; ACEI, ARBs, or ARNIs; and MRAs-spironolactone).1
There were no echo entry criteria, but patients needed to have a proBNP of > 160 pmol/l at entry).
In the high-intensity care arm, oral HF medications were up-titrated to 50% of recommended doses before discharge and to 100% of recommended doses within 2 weeks of discharge.
More effective decongestion was achieved despite a lower mean daily dose of loop diuretics at day 90. The high-intensity care arm had a significantly better chance of sustaining decongestion at day 90. Successful decongestion resulted in a lower risk of 180-day HF readmission or all-cause death (HR: 0.40; 95% CI: 0.27-0.59).
If not suggested on discharge, consider discussing with your cardiology team. Note ARNIS (Entresto) is only funded for ejection fraction < 35%.
As published in NZ Doctor and Research Review
