Congestive heart failure ACE inhibitors

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Summary
Acute Pharmacotherapy
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ACC/AHA Guideline Recommendations

Initial and Serial Evaluation of the HF Patient
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Sudden Cardiac Death Prevention
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Patients at high risk for developing heart failure (Stage A)
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Congestive heart failure end-of-life considerations

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Patients who have concomitant disorders
Obstructive Sleep Apnea in the Patient with CHF
NSTEMI with Heart Failure and Cardiogenic Shock

Congestive heart failure ACE inhibitors On the Web

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Editor(s)-In-Chief: James Chang, M.D., Cardiovascular Division Beth Israel Deaconess Medical Center, Boston MA, Harvard Medical School [1] and C. Michael Gibson, M.S., M.D. [2], Cardiovascular Division Beth Israel Deaconess Medical Center, Boston MA, Harvard Medical School; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [3];Seyedmahdi Pahlavani, M.D. [4] Edzel Lorraine Co, DMD, MD[5]

Overview

The Collaborative Group on ACE Inhibitor Trials demonstrated significant reduction in total mortality and hospitalization with the administration of ACEIs that was consistent among wide range of patients.[1]

ACE Inhibitors

Indications for ACE Inhibitors Use

1. The left ventricular ejection fraction (LVEF) is ≤ 40%

or

2. There is a prior history of myocardial infarction (MI)

Background

Dosing

  • ACE-I or ARB therapy should be initiated at low dosage such as 12.5 mg tid of captopril, 2.5 mg bid of enalapril[2][3], or 2.5 mg daily lisinopril.
  • Every 4 to 6 weeks the dose is gradually uptitrated, as tolerated, toward target dosages of 20-40 mg daily for lisinopril, 10-20 mg twice daily for enalapril maleate, and 50-100 mg three times a day for captopril, or to the maximum tolerated dosage.
  • ACE inhibitors are rarely adequate for the treatment of congestion without the use of diuretics.

Complications

2022 AHA/ ACC/ HFSA Heart Failure Guideline/ 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America ((DO NOT EDIT) [6][7][8]

Renin-Angiotensin System Inhibition With ACEi or ARB or ARNi

Class I
"1. In patients with HFrEF and NYHA class II to III symptoms, the use of ARNi is recommended to reduce morbidity and mortality. [9][10][11][12][13](Level of Evidence: A) "
"2. In patients with previous or current symptoms of chronic HFrEF, the use of ACEi is beneficial to reduce morbidity and mortality when the use of ARNi is not feasible.[3][2][14][15][16][17][1][18] (Level of Evidence: A) "
"3. In patients with previous or current symptoms of chronic HFrEF who are intolerant to ACEi because of cough or angioedema and when the use of ARNi is not feasible, the use of ARB is recommended to reduce morbidity and mortality. [19][20][21][22][23] (Level of Evidence: A) "
"5. In patients with chronic symptomatic HFrEF NYHA class II or III who tolerate an ACEi or ARB, replacement by an ARNi is recommended to further reduce morbidity and mortality. [9][10][11][12][13](Level of Evidence: B-R) "
Class Value Statement: High Value
"4. In patients with previous or current symptoms of chronic HFrEF, in whom ARNi is not feasible, treatment with an ACEi or ARB provides high economic value. [24][25][26][27][28][29][30](Level of Evidence: A) "
"6. In patients with chronic symptomatic HFrEF, treatment with an ARNi instead of an ACEi provides high economic value. [31][32][33][34] (Level of Evidence: A) "
Class III (Harm)
"7. ARNi should not be administered concomitantly with ACEi or within 36 hours of the last dose of an ACEi. [35][36] (Level of Evidence: B-R) "
"8. ARNi should not be administered to patients with any history of angioedema.[37][38][39][40] (Level of Evidence: C-LD) "
"9. ACEi should not be administered to patients with any history of angioedema. [41][42][43][44] (Level of Evidence: C-LD) "

Vote on and Suggest Revisions to the Current Guidelines

External Links

References

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  45. Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW (May 2022). "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". Circulation. 145 (18): e895–e1032. doi:10.1161/CIR.0000000000001063. PMID 35363499 Check |pmid= value (help).
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