Heart Failure Fact or Fiction: Optimizing GDMT: Dose vs. Mechanism of Action

A 64-year-old man with heart failure (HF) with reduced ejection fraction (25%) due to ischemic cardiomyopathy presents to the emergency department with acute decompensated HF. He is successfully treated with intravenous loop diuretics and achieves euvolemia. He is hemodynamically stable with renal function and electrolytes within reference ranges.

Prior to discharge, the clinician reviews his medications and considers optimization of his guideline-directed medical therapy (GDMT). He is currently on sacubitril/valsartan 24/26 mg twice daily and metoprolol succinate 25 mg daily.

The patient should start on a sodium-glucose cotransporter-2 inhibitor (SGLT2i) and mineralocorticoid-receptor antagonist (MRA) with plans for further titration of his regimen soon.

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