geoffrey modest medical blogs

  A recent article reviewed outpatient initiation of sacubitril/valsartan in those with heart failure ( see  heart failure outpt entresto JCadriovascPharm2021 in dropbox, or  DOI:  10.1097/FJC.0000000000000966 ). The heart failure guidelines just released  elevated sacubitril/valsartan to the highest tier (see  http://gmodestmedblogs.blogspot.com/2022/05/ahaacc-guidelines-on-heart-failure.html  . In order for sacubitril/valsartan to be a practical solution for the huge number of patients with HF, it is important to have a safe and efficient ability to initiate this med.     Details: -- 250 adults were  prescribed sacubitril/valsartan in cardiology clinics in an academic institution from 2016-2018  in this retrospective cohort study with follow-up data collected until 3 months after medication initiation -- average age 63, 74% males, 89% white -- NYHA symptom class II in 64/ III in 31%; ejection fraction reduced in 94% (EF not quantified in the text) -- hypertension 74%/di

  The American Heart Association, American College of Cardiology, and the Heart Failure Society of America recently published an update of the 2013 multisociety guideline as well as the more recent 2017 update. For the full 159-page document, see  https://reader.elsevier.com/reader/sd/pii/S0735109721083959?token=CB9580AA49BDFBDED37DEAE7D70EE6A62D8C458BE5FB7885772CC1A1152D557D66CEEB34771305D43089105C9545D082&originRegion=us-east-1&originCreation=20220521232432  ; for the 24-page executive summary, see   heart failure guidelines AHA etc JACC2022   in dropbox, or  https://doi.org/10.1016/j.jacc.2021.12.011 ) ​ Review of guidelines : -- stages of heart failure (HF), revised:     -- stage A: HF prevention: asymptomatic, modify risk factors (hypertension, atherosclerotic disease, diabetes, metabolic syndrome, obesity)     -- stage B: asymptomatic, but evidence of reduced left or right ventricular systolic function, ventricular hypertrophy, chamber enlargement, wall motion abnormaliti