Initiating Heart Failure Medications

Patient Selection and Monitoring

• The European Society of Cardiology recommends that furosemide can be started without direct examination in patients with heart failure if the diagnosis is clear and the patient is stable, with recent labs showing renal function and electrolytes, and the patient is instructed to monitor daily weights and report weight gain 2
• The European Society of Cardiology guidelines state that beta-blockers should not be initiated without direct patient assessment, especially in patients with recent heart failure exacerbation, due to the risk of temporary symptomatic deterioration and the need for in-person evaluation to ensure patient safety 1

Beta-Blocker Initiation

• The European Society of Cardiology recommends that beta-blocker therapy should only be initiated in stable, euvolemic patients with no contraindications, and that direct evaluation for signs of persistent congestion, heart rate assessment, and blood pressure measurement are necessary before initiation 3, 1
• The American Heart Association and European Society of Cardiology recommend using only evidence-based beta-blockers, such as metoprolol CR/XL, bisoprolol, or carvedilol, and planning for gradual up-titration at 2-week intervals with close monitoring 3, 1

Critical Pitfalls to Avoid

• The European Society of Cardiology warns that starting beta-blockers remotely can lead to temporary symptomatic deterioration in 20-30% of patients, and that abrupt discontinuation carries risk of rebound myocardial ischemia and arrhythmias 2, 4