CME credit available from Harvard Medical School through September 2024.
The goal of this educational program is to provide primary care clinicians with a review of evidence-based practices for the evaluation and management of heart failure in primary care settings, including summaries of recent changes to HF treatment guidelines.
Despite recent incentives and improvements in care, heart failure continues to be a leading cause of hospitalization in the U.S.1,2 Ensuring patients are on guideline directed medical therapy is one way to reduce rehospitalization. Yet many patients are not on recommended therapy.3,4
Guideline recommended treatment depends on heart failure symptoms and ejection fraction (EF).
HF with reduced EF EF <40%
HF with preserved EF EF >50%
These medications have been shown to reduce HF hospitalization and death for people with HFrEF. Other options may be useful in specific patient cases: hydralazine/isosorbide, ivabradine, vericiguat, and digoxin.
Patients with HFpEF do not have the same response to the four pillars. Recently, data on empagliflozin suggests a benefit in HF hospitalization and mortality for patients with HFpEF regardless of the diagnosis of diabetes.6
The trial for empagliflozin is groundbreaking because previous trials of medications in HFpEF have not shown clear benefit. Analysis of these prior trials suggests that benefit seen may vary based on the EF.
For patients who have advancing or advanced heart failure, discussions about goals of care and treatment options available become critical. One registry of patients with heart failure found patients with advanced heart failure are not always prepared to make end-of-life decisions, with more than 1 in 3 not having either a health care proxy or advance care directive in place.7 For more on talking to patients with serious illness, like heart failure, see Alosa’s Serious Illness module.
Information current at time of publication, September 2021.
The content of this website is educational in nature and includes general recommendations only; specific clinical decisions should only be made by a treating clincian based on the individual patient’s clinical condition.