Patient handout

Heart failure (chronic, GDMT titration)

PRODUCTION

1. Your condition

This handout is for heart failure (chronic, gdmt titration). Your care team identified this based on: dyspnea on exertion / orthopnea / pnd.

Other reasons your team may use this plan: lower-extremity edema; nt-probnp elevated; echo lvef reduced/borderline.

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
sacubitril/valsartan	24/26 mg (49/51 if ACEi/ARB-tolerant)	PO	BID	Pillar 1 — PARADIGM-HF CV death/HHF HR 0.80 (0.73–0.87), all-cause death HR 0.84 (0.76–0.93); ARNi preferred de novo. 2022 AHA/ACC/HFSA Class I (PMID 25176015)
carvedilol	3.125 mg	PO	BID	Pillar 2 — COPERNICUS all-cause death 35% RRR (95% CI 19–48%); reverse remodelling over 3–6 mo. Class I (PMID 11386263)
metoprolol succinate	12.5–25 mg	PO	once daily	Pillar 2 alt — MERIT-HF all-cause death RR 0.66 (0.53–0.81); CR/XL long-acting only (PMID 10376614)
bisoprolol	1.25 mg	PO	once daily	Pillar 2 alt — CIBIS-II all-cause death HR 0.66 (0.54–0.81) (PMID 10023943)
spironolactone	12.5–25 mg	PO	once daily	Pillar 3 — RALES all-cause death RR 0.70 (0.60–0.82); HHF RR 0.65 (0.54–0.77). Class I (PMID 10471456)
eplerenone	25 mg	PO	once daily	Pillar 3 alt — EMPHASIS-HF CV death/HHF HR 0.63 (0.54–0.74); endocrine-ADR sparing (PMID 21073363)
dapagliflozin	10 mg	PO	once daily	Pillar 4 — DAPA-HF worsening HF/CV death HR 0.74 (0.65–0.85); benefit DM-independent; curve separation by ~28 d. Class I (PMID 31535829)
empagliflozin	10 mg	PO	once daily	Pillar 4 alt — EMPEROR-Reduced CV death/HHF HR 0.75 (0.65–0.86) (PMID 32865377)

Plan: GDMT 4-pillar — HFrEF (LVEF ≤40) — rapid simultaneous initiation (2024 ACC Consensus + STRONG-HF)

3. When to call your provider

Contact your care team if any of the following happen:

Acute decompensation (rest dyspnea, pulmonary edema) → ED + route to cardio.acute-hf.core.v1 — ACC/AHA 2022
SBP <90 + signs of hypoperfusion → ED + cardiogenic shock workup — ACC/AHA 2022 §10
NYHA IV despite optimised the four foundational heart-failure medications, recurrent HF hospitalisations, escalating diuretic need, persistent VT/VF, worsening renal function with diuresis → advanced HF referral (LVAD / transplant / palliative) — ACC/AHA 2022 §8
New AF with rapid ventricular response → rate/rhythm strategy + anticoagulation — ACC/AHA 2022 §7.3.7

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Serum K >5.5 mmol/L on MRA (spironolactone/eplerenone) or finerenone — ACC/AHA 2022 §7.3.3
Creatinine rise ≥0.5 mg/dL (or ≥30%) from baseline on loop diuretic + ACEi/ARNI/ARB — ACC/AHA 2022
NYHA class progression (e.g., II → III, III → IV) despite optimised the four foundational heart-failure medications — ACC/AHA 2022 §8
Symptomatic SBP <90 mmHg on ACEi/ARNI/ARB ± beta-blocker ± MRA — ACC/AHA 2022
SBP <90 with signs of hypoperfusion (cool extremities, AMS, oliguria, lactate >2) — ACC/AHA 2022 §10(life-threatening)

5. Follow-up

Visit cadence by NYHA + recent titration; cardiac rehab referral; vaccination check (flu, pneumococcal, COVID) — ACC/AHA 2022 §7.3.8

6. Sources

Guideline: 2022 AHA/ACC/HFSA HF Guideline (Circulation 35363499 / JACC 35379503) + 2024 ACC HFrEF Expert Consensus (38466244) + ESC 2021 HF (34447992) + 2023 ESC Focused Update (37622666) + FINEARTS-HF (2024)