ÎÎAldosterone receptor antagonists are recommended to reduce
morbidity and mortality following an acute MI in patients who have
LVEF of 40% or less who develop symptoms of HF or who have a
history of diabetes mellitus, unless contraindicated. (I-B)
ÎÎInappropriate use of aldosterone receptor antagonists is potentially
harmful because of life-threatening hyperkalemia or renal
insufficiency when serum creatinine is greater than 2.5 mg/dL in men
or greater than 2.0 mg/dL in women (or estimated glomerular filtration
rate <30 mL/min/1.73 m2), and/or potassium greater than 5.0 mEq/L.
(III-B: Harm)
Hydralazine and Isosorbide Dinitrate
ÎÎThe combination of hydralazine and isosorbide dinitrate is
recommended to reduce morbidity and mortality for patients selfdescribed as African Americans with NYHA class III–IV HFr EF
receiving optimal therapy with ACE inhibitors and beta blockers,
unless contraindicated. (I-A)
ÎÎA combination of hydralazine and isosorbide dinitrate can be useful
to reduce morbidity or mortality in patients with current or prior
symptomatic HFr EF who cannot be given an ACE inhibitor or ARB
because of drug intolerance, hypotension, or renal insufficiency,
unless contraindicated. (IIa-B)
Digoxin
ÎÎDigoxin can be beneficial in patients with HFr EF, unless
contraindicated, to decrease hospitalizations for HF. (IIa-B)
Anticoagulation
ÎÎPatients with chronic HF with permanent/persistent/paroxysmal
AF and an additional risk factor for cardioembolic stroke (history of
hypertension, diabetes mellitus, previous stroke or transient ischemic
attack, or ≥75 years of age) should receive chronic anticoagulant
therapy (in the absence of contraindications to anticoagulation). (I-A)
ÎÎThe selection of an anticoagulant agent (warfarin, dabigatran,
apixaban, or rivaroxaban) for permanent/persistent/paroxysmal AF
should be individualized on the basis of risk factors, cost, tolerability,
patient preference, potential for drug interactions, and other clinical
characteristics, including time in the international normalized ratio
therapeutic range if the patient has been taking warfarin. (I-C)
ÎÎChronic anticoagulation is reasonable for patients with chronic HF
who have permanent/persistent/paroxysmal AF but are without an
additional risk factor for cardioembolic stroke (in the absence of
contraindications to anticoagulation). (IIa-B)
ÎÎAnticoagulation is NOT recommended in patients with chronic HFr EF
without AF, a prior thromboembolic event, or a cardioembolic source.
(III-B: No Benefit)
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