Drug therapy for heart failure with reduced ejection fraction: what is the ‘right’ dose?

Kondo, T., Jhund, P. S. and McMurray, J. J.V. (2022) Drug therapy for heart failure with reduced ejection fraction: what is the ‘right’ dose? European Journal of Heart Failure, 24(3), pp. 421-430. (doi: 10.1002/ejhf.2447) (PMID:35119172)

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Abstract

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.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Kondo, Dr Toru and Jhund, Dr Pardeep and McMurray, Professor John
Authors: Kondo, T., Jhund, P. S., and McMurray, J. J.V.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:European Journal of Heart Failure
Publisher:Wiley
ISSN:1388-9842
ISSN (Online):1879-0844
Published Online:04 February 2022
Copyright Holders:Copyright © 2022 The Authors
First Published:First published in European Journal of Heart Failure 24(3): 421-430
Publisher Policy:Reproduced under a Creative Commons License

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