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Heart Failure Cheat Sheet (DRAFT) by

Guideline-directed treatment for Heart Failure

This is a draft cheat sheet. It is a work in progress and is not finished yet.

GDMT for Heart Failure Stage C

GDMT for Heart Failure

Class
Place of Therapy
ARNIs
Preferred first-line RAAS agent for ALL patients with Stage C HFrEF (NYHA class II–IV)
ACEIs
Recomm­ended for patients who cannot tolerate ARNi (e.g., due to cost, prior angioedema to ARNi compon­ents, or hemody­namic limita­tions).
ARBs
Second­-line RAAS therapy, used when patients cannot tolerate ACEi (most commonly due to cough) or ARNi.
Beta-B­lockers
Mandatory component of GDMT for all patients with Stage C HFrEF (NYHA class I–IV) who have current or previous symptoms.
MRAs
Recomm­ended for all eligible patients with HFrEF and NYHA class II–IV symptoms.
SGLT2is
Recomm­ended for ALL patients with sympto­matic HFrEF regardless of the presence of T2DM.
Loop & Thiazide Diuretic
Primary agents for decong­estion in Stage C HFrEF, used to manage volume overload, relieve dyspnea, edema, and orthopnea.

Monitoring Parameters

Drug Class
Monitoring Parameter
ARNIs
• Electr­olytes (K⁺, Na⁺), SCr/eGFR
• BP | HR | S/Sx of HF
ACEIs / ARBs
• Serum electr­olytes (K⁺) at baseline, 1–2 weeks after initia­tio­n/t­itr­ation, and every 3–6 months
• Vitals (BP, HR)
• Renal function (SCr, BUN)
Beta-B­lockers
• Vitals (HR, BP)
• Fluid status, S/Sx at each titration visits
• Avoid abrupt withdrawal
MRAs
• Serum K⁺ and SCr/eGFR w/in 1 week of initiation and after each dose adjust­ment; then monthly for 3 months; then every 3–6 months when stable.
• Recheck with any interc­urrent illness, dehydr­ation, or medication changes
SGLT2is
• eGFR, BP, signs of volume depletion, UTI
• Glucose in diabetic patients
• Hold if patient is NPO or acutely ill
Loop & Thiazide Diuretics
• Daily weights (patient self-m­oni­tor­ing), BP, HR
• BMP (Na⁺, K⁺, Mg²⁺, BUN, SCr) at initiation and period­ically
• Electr­olytes more frequently when doses adjusted or with illness
Hydral­azi­ne/­iso­sorbide dinitrate (H-ISDN)
• Vitals (BP, HR); CBC period­ically
• S/Sx of Lupus (ANA if clinically suspec­ted), adherence assessment given pill burden
Ivabradine
• Resting HR (target 55–60 bpm)
• ECG rhythm (monitor for AF), BP
• Visual symptoms
Vericiguat
• BP , HR, S/Sx HF
• CBC (Hgb/Hct), Renal function
Digoxin
• Digoxin concen­tration (target 0.5–<0.9 ng/mL; check 6–8 hours post-dose at steady state)
• Renal function (SCr, eGFR), electr­olytes (K⁺, Mg²⁺, Ca²⁺), ECG (PR interval, rhythm)
• Symptoms of toxicity at every visit
 

Dosing of 4 Pillars Therapy

Agents
Starting Dose
Target Dose
Sacubitril/
Valsartan
49 mg/51 mg BID
97 mg/103 mg BID
Captopril
Enalapril
Lisinopril
Fosinopril
Ramipril
Trando­lapril
Perind­opril
Quinapril
6.25 mg TID
2.5 mg BID
2.5–5 mg daily
5–10 mg daily
1.25–2.5 mg daily
1 mg daily
2 mg daily
5 mg BID
50 mg TID
10–20 mg BID
20–40 mg daily
40 mg daily
10 mg daily
4 mg daily
8–16 mg daily
20 mg BID
Candes­artan
Losartan
Valsartan
4–8 mg daily
25–50 mg daily
20–40 mg daily
32 mg daily
50–150 mg daily
160 mg BID
Bisoprolol
Carvedilol
Carvedilol CR
Metoprolol succinate ER
1.25 mg daily
3.125 mg BID
10 mg daily
12.5–25 mg daily
10 mg daily
25–50 mg BID
80 mg daily
200 mg daily
Spiron­ola­ctone
Eplerenone
12.5–25 mg daily
25–50 mg daily
25 mg daily
50 mg daily
Dapagl­iflozin
Empagl­iflozin
10 mg once daily
Fixed dose; no titration required

DIURETICS: LOOP AND THIAZIDE

Agent
Initial TDD
Max TDD
DOA
Loop Diuretics
      
Furosemide
Bumetanide
Torsemide
20–40 mg QD-BID
0.5–1.0 mg QD-BID
10–20 mg QD
600 mg
10 mg
200 mg
6–8 hours
4–6 hours
12–16 hours
Thiazide Diuretics
      
Hydroc­hlo­rot­hiazide
Metolazone
Chlort­hal­idone
Indapamide
25 mg QD-BID
2.5 mg QD
12.5–25 mg QD
2.5 mg QD
200 mg
20 mg
100 mg
5 mg
6–12 hours
12–24 hours
24–72 hours
36 hours