Acute Decompensated Heart Failure: Treatment with Guideline Directed Medical Therapy and Discharge Planning

A number of medications including ACE inhibitors, ARBs, β-blockers, mineralocorticoid receptor antagonists (MRAs), and the combination of hydralazine/isosorbide dinitrate (in black patients) have been shown, in prospective randomized placebo-controlled clinical trials, to improve symptoms, decrease mortality and decrease hospitalization in ambulatory patients with heart failure with reduced ventricular systolic function [1–11]. Randomized studies of these agents have not been conducted in patients hospitalized for ADHF. The ACCF/AHA guidelines recommend that heart failure medications be carefully reviewed on admission and that appropriate changes be made during hospitalization. Chronic maintenance therapy with guideline-directed medical therapy (GDMT) should, in general, be continued during hospitalization for ADHF and GDMT should be initiated in patients with ADHF and HFrEF who are not receiving chronic heart failure medications [12]. The HFSA guidelines emphasize that hospitalization for ADHF is an “excellent opportunity” to optimize a patient’s chronic oral medical regimen [13]. The ESC guidelines recommend that GDMT should be continued on admission or should be started as soon as possible in patients with HFrEF [14].