269.4 📌 章末速蚘

269.4.0.0.1 HFrEF — Quadruple Therapy (2024)
  1. ARNI (sacubitril/valsartan) — preferred
  2. β-blocker (carvedilol, metoprolol succinate, bisoprolol)
  3. MRA (spironolactone, eplerenone)
  4. SGLT2i (dapagliflozin, empagliflozin)
269.4.0.0.2 HFrEF Additional
  • Loop diuretics (symptoms), ivabradine (sinus + HR ≥ 70), hydralazine + nitrates (African American NYHA III-IV), digoxin (symptoms + AF), IV iron (deficiency)
269.4.0.0.3 HFpEF Management 2024
  • SGLT2i Class I (DELIVER + EMPEROR-Preserved)
  • Diuretics for symptoms
  • Tirzepatide/Semaglutide for HFpEF + obesity (STEP-HFpEF 2024)
  • Finerenone modest benefit (FINEARTS-HF 2024)
  • Optimal comorbidity management
269.4.0.0.4 Specific HFpEF Sub-Therapies
  • ATTR amyloidosis: tafamidis, patisiran
  • HCM: mavacamten (myosin inhibitor)
269.4.0.0.5 Devices
  • ICD (EF ≀ 35% + NYHA II-III on optimal Tx ≥ 3 mo)
  • CRT (EF ≀ 35% + LBBB + QRS > 130 + NYHA II-III)
  • LVAD (advanced HF; bridge to transplant or destination)
269.4.0.0.6 Advanced HF
  • Heart transplant (1-yr 90%, 5-yr 75%)
  • Palliative care
269.4.0.0.7 Key Trials
  • PARADIGM-HF: ARNI > ACEi
  • DAPA-HF + EMPEROR-Reduced: SGLT2i for HFrEF
  • DELIVER + EMPEROR-Preserved: SGLT2i for HFpEF
  • STEP-HFpEF: tirzepatide/semaglutide for HFpEF + obesity
  • FINEARTS-HF: finerenone for HFpEF + HFmrEF
  • STRONG-HF: rapid initiation of GDMT
269.4.0.0.8 盧醫垫 hint
  • HFrEF: rapid initiation of quadruple therapy (ARNI + β-blocker + MRA + SGLT2i) early
  • HFpEF: SGLT2i first; tirzepatide / semaglutide if obese
  • EF ≀ 35% + LBBB: CRT
  • EF ≀ 35% + NYHA II-III on optimal Tx: ICD
  • Cardiac amyloidosis ATTR: tafamidis
  • HCM obstructive symptomatic: mavacamten
  • Advanced HF: LVAD bridge to transplant or destination