Management of Chronic Systolic Heart Failure

Guideline-Directed Medical Therapy (GDMT)

• The American College of Cardiology/American Heart Association (ACC/AHA) recommends optimization of ACE inhibitor and beta-blocker doses to improve blood pressure control and provide mortality benefit in patients with chronic systolic heart failure 2, 3
• The target dose for lisinopril is 20-40 mg daily, and for metoprolol succinate, it is 200 mg daily, according to ACC/AHA guidelines 3
• The American College of Cardiology recommends uptitrating lisinopril and metoprolol succinate gradually to achieve target doses, while monitoring blood pressure, potassium, and creatinine 2, 3
• The addition of a mineralocorticoid receptor antagonist (MRA), such as spironolactone, is recommended for patients with symptomatic heart failure despite ACE inhibitor and beta-blocker therapy, according to ACC/AHA guidelines 2, 3

Diuretic Management

• The American College of Cardiology recommends continuing furosemide 20 mg daily and metolazone 2.5 mg three times weekly for diuretic management in patients with fluid overload 1, 2
• Monitoring daily weights and reporting weight gain >2-3 lbs in 1 day or >5 lbs in 1 week is essential for managing fluid overload 4

Hypertension Management

• The American College of Cardiology recommends a target blood pressure of <130/80 mmHg for patients with heart failure, and optimization of ACE inhibitor and beta-blocker doses can help achieve this goal 5, 7
• Avoiding calcium channel blockers, except amlodipine, for blood pressure control is recommended, as they can worsen heart failure 5, 7

Fall Risk Management

• The American College of Cardiology recommends assessing for orthostatic hypotension and monitoring blood pressure supine and standing in patients with a history of falls 4
• Intensive physical therapy for fall prevention and functional recovery is recommended for patients with a history of falls 4

Monitoring Parameters

• Daily monitoring of weights, vital signs, and symptoms, as well as laboratory monitoring of electrolytes and renal function, is essential for managing patients with chronic systolic heart failure 1, 4
• The American College of Cardiology recommends rechecking labs in 1 week after any medication changes and monitoring potassium and creatinine closely after initiating MRA therapy 1, 3, 6