Why the study?
New guidelines emphasize rapidly initiating four key life-saving therapies in heart failure with reduced ejection fraction over titration to target dose, prompting a re-examination of dosing evidence.
Answers are grounded in this paper and cite their sources.
This review supports the rapid initiation of all four foundational HFrEF therapies at low doses rather than delaying initiation to titrate individual drugs to target doses.
New guidelines have emphasized the primacy of starting the four key life-saving therapies for patients with heart failure and reduced ejection fraction as quickly as possible, with titration to 'target dose' of these, as secondary consideration. In this article, we examine the reasons for this change in emphasis and revisit the evidence regarding the dosing of pharmacological therapy in heart failure. We demonstrate the early benefits obtained with even low doses of most of the foundational therapies for heart failure and reduced ejection fraction. We also clarify that the 'target dose' of those therapies requiring titration was a goal based on tolerability and often not reached in trials, i.e. the proven benefits of our foundational therapies were demonstrated with an average dose that was less than target and many patients in these trials were treated with sub-target doses.
No takes yet. Share an insight, caveat, or question.
Kondo et al. (2022) studied this question.
Synapse has enriched 10 related papers. Consider them for comparative context: