Shumit/Heart-Failure-Text · Datasets at Hugging Face

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Step 1: ACEi/ARB/ARNI, Beta Blockers

ACEI/ARB/ARNI: They reduce salt and water retention and open up blood vessels. This makes it easier for your heart to pump blood to your body.

Beta Blockers: They block adrenaline so your heart does not have to work as hard and beat as fast.

Step 2: ACEi/ARB/ARNI, Beta Blockers, MRA

ACEI/ARB/ARNI: They reduce salt and water retention and open up blood vessels. This makes it easier for your heart to pump blood to your body.

Beta Blockers: They block adrenaline so your heart does not have to work as hard and beat as fast.

MRA: They block stress hormones that make the heart stiff and cause scarring.

Step 3: ACEi/ARB/ARNI, Beta Blockers, MRA, SGLT2i

ACEI/ARB/ARNI: They reduce salt and water retention and open up blood vessels. This makes it easier for your heart to pump blood to your body.

Beta Blockers: They block adrenaline so your heart does not have to work as hard and beat as fast.

MRA: They block stress hormones that make the heart stiff and cause scarring.

SGLT2i: They help lower stress on your heart.

Step 4: ACEi/ARB/ARNI, Beta Blockers, MRA, SGLT2i, ARNI

ACEI/ARB/ARNI: They reduce salt and water retention and open up blood vessels. This makes it easier for your heart to pump blood to your body.

Beta Blockers: They block adrenaline so your heart does not have to work as hard and beat as fast.

MRA: They block stress hormones that make the heart stiff and cause scarring.

SGLT2i: They help lower stress on your heart.

ARNI: They reduce salt and water retention and open up blood vessels. This makes it easier for your heart to pump blood to your body.

Depending on your unique health situation, your health care team may use either approach, or a combination approach, to best suit you and your needs.

How Are Medications Increased?
Medications are introduced at low doses and gradually, based on your response. This process is called “titration.” During titration, your health care provider will assess your symptoms, ask about any side effects and monitor your bloodwork as needed. The doses of your medication may be adjusted (increased or decreased) based on your response.

Here is how titration works:
Medication titration consists of adjusting a dose every 1 to 4 weeks, depending on how well you are tolerating changes and on the timing of follow-up appointments with your health care team.

Beyond Optimal Medication
There is no “one-size-fits-all.” For some people, optimal medical therapy will mean fewer medications than the 4 in the guidelines. You could need to avoid a medication due to a contraindication or because of how it interacts with another drug you are taking. People with heart failure are often on medications to treat other conditions, such as high cholesterol (“statins”), or to reduce the risk of blood clots (“blood thinners”). You might also be prescribed other medications not described here like water pills or diuretics, digoxin or ivabradine.

How does my health care team measure my response to treatment?

After you are on maximally tolerated doses of your medication for 3 to 6 months, your health care provider will discuss ordering an echocardiogram or other diagnostic test with you to reassess your ejection fraction. Those results may guide next steps, such as a referral for pacemaker, implantable cardioverter defibrillator (ICD), or a cardiac synchronization therapy device (CRT or CRT-D). You may not need any further drug changes, or you may need to consider other medications to help your heart.

Ongoing evaluations with your team

Most people with heart failure will need to continue medications long-term, many for the rest of their lives. In addition to taking medications as prescribed, learning about self-care is an important part of managing heart failure. Note any new symptoms, side effects or changes in your quality of life. Talk to your health care provider about how you feel you are managing. Never adjust your own medications without guidance from your health care team.

Helpful Resources

Ask questions, take notes and make sure you feel comfortable with the treatment options being offered and chosen.

Resources that may be helpful to you, your caregiver or family: https://hqontario.ca/Portals/0/documents/evidence/quality-standards/qs-heart-failure-patient-guide-en.pdf, https://heartlife.ca/toolkit/, https://ourhearthub.ca/

Managing Your Care and Medications

-Take medications as prescribed by your healthcare team.
-Do not adjust your medications unless instructed by your healthcare team.
-If you are vomiting, experiencing diarrhea, or are dehydrated, you may need to stop taking some medications for a short time.
-Work with your team to determine the best treatment.
-Keep a list of the name, dosage, how often, and why you take each of your medications in your wallet or on your phone.
-Don’t take over-the-counter medicine, vitamins, or supplements without checking first with your doctor or pharmacist. Medications to AVOID include: Anti-inflammatory medications like ibuprofen (Advil™, Motrin™) or naproxen (Aleve™), Decongestant pills (“cold & sinus”) that include pseudoephedrine or phenylephrine, Acetylsalicylic acid (Aspirin), except for the 81-mg dose if prescribed or recommended by your healthcare team.

Know what side effects to watch out for and discuss them with your healthcare provider in a timely fashion.

-Be patient and understand that it may take time for your body to adapt to certain medications.
-If you are not sure what to do with your medications when dehydrated, ask your healthcare team about sick day management of your medications.
-Try to be consistent with the time of day that you take your medication. Timing when you take your medication with another activity that you do at the same time every day, such as brushing your teeth, can be helpful.
-Keep a list of everyone on your heart failure team (doctors, pharmacists, peer support, caregivers) and carry it with you to appointments.
-Notify your healthcare team if any changes are made to your medicines by a different provider.

Glossary of Terms

Adrenaline

Also known as “epinephrine”, this is a chemical messenger that controls the sympathetic nervous system and causes the "fight or flight" response.

Contraindication

Anything (i.e., a symptom or medical condition) that is a reason for a person to not receive a particular treatment or procedure because it may be harmful.

Diuretics

Diuretics (commonly called ‘water pills’) rid the body of excess fluid, help to reduce swelling and bloating and make it easier to breathe.

Echocardiogram

An echocardiogram (ECHO) is an ultrasound of the heart that shows details of the heart’s structure and function.

Guideline-directed medical therapy (GDMT)

Wherever possible, CCS/CHFS Heart Failure Guidelines recommend that people with HFrEF be treated with 4 different types of medications early after diagnosis. This combination of medications is known as GDMT.

Step 1: ACEi/ARB/ARNI, Beta Blockers

ACEI/ARB/ARNI: They reduce salt and water retention and open up blood vessels. This makes it easier for your heart to pump blood to your body.

Beta Blockers: They block adrenaline so your heart does not have to work as hard and beat as fast.

Step 2: ACEi/ARB/ARNI, Beta Blockers, MRA

ACEI/ARB/ARNI: They reduce salt and water retention and open up blood vessels. This makes it easier for your heart to pump blood to your body.

Beta Blockers: They block adrenaline so your heart does not have to work as hard and beat as fast.

MRA: They block stress hormones that make the heart stiff and cause scarring.

Step 3: ACEi/ARB/ARNI, Beta Blockers, MRA, SGLT2i

ACEI/ARB/ARNI: They reduce salt and water retention and open up blood vessels. This makes it easier for your heart to pump blood to your body.

Beta Blockers: They block adrenaline so your heart does not have to work as hard and beat as fast.

MRA: They block stress hormones that make the heart stiff and cause scarring.

SGLT2i: They help lower stress on your heart.

Step 4: ACEi/ARB/ARNI, Beta Blockers, MRA, SGLT2i, ARNI

ACEI/ARB/ARNI: They reduce salt and water retention and open up blood vessels. This makes it easier for your heart to pump blood to your body.

Beta Blockers: They block adrenaline so your heart does not have to work as hard and beat as fast.

MRA: They block stress hormones that make the heart stiff and cause scarring.

SGLT2i: They help lower stress on your heart.

ARNI: They reduce salt and water retention and open up blood vessels. This makes it easier for your heart to pump blood to your body.

Depending on your unique health situation, your health care team may use either approach, or a combination approach, to best suit you and your needs.

How Are Medications Increased?

Medications are introduced at low doses and gradually, based on your response. This process is called “titration.” During titration, your health care provider will assess your symptoms, ask about any side effects and monitor your bloodwork as needed. The doses of your medication may be adjusted (increased or decreased) based on your response.

Here is how titration works:

Medication titration consists of adjusting a dose every 1 to 4 weeks, depending on how well you are tolerating changes and on the timing of follow-up appointments with your health care team.

Beyond Optimal Medication

There is no “one-size-fits-all.” For some people, optimal medical therapy will mean fewer medications than the 4 in the guidelines. You could need to avoid a medication due to a contraindication or because of how it interacts with another drug you are taking. People with heart failure are often on medications to treat other conditions, such as high cholesterol (“statins”), or to reduce the risk of blood clots (“blood thinners”). You might also be prescribed other medications not described here like water pills or diuretics, digoxin or ivabradine.

How does my health care team measure my response to treatment?

After you are on maximally tolerated doses of your medication for 3 to 6 months, your health care provider will discuss ordering an echocardiogram or other diagnostic test with you to reassess your ejection fraction. Those results may guide next steps, such as a referral for pacemaker, implantable cardioverter defibrillator (ICD), or a cardiac synchronization therapy device (CRT or CRT-D). You may not need any further drug changes, or you may need to consider other medications to help your heart.

Ongoing evaluations with your team

Most people with heart failure will need to continue medications long-term, many for the rest of their lives. In addition to taking medications as prescribed, learning about self-care is an important part of managing heart failure. Note any new symptoms, side effects or changes in your quality of life. Talk to your health care provider about how you feel you are managing. Never adjust your own medications without guidance from your health care team.

Helpful Resources

Ask questions, take notes and make sure you feel comfortable with the treatment options being offered and chosen.

Resources that may be helpful to you, your caregiver or family: https://hqontario.ca/Portals/0/documents/evidence/quality-standards/qs-heart-failure-patient-guide-en.pdf, https://heartlife.ca/toolkit/, https://ourhearthub.ca/

Managing Your Care and Medications

-Take medications as prescribed by your healthcare team.

-Do not adjust your medications unless instructed by your healthcare team.

-If you are vomiting, experiencing diarrhea, or are dehydrated, you may need to stop taking some medications for a short time.

-Work with your team to determine the best treatment.

-Keep a list of the name, dosage, how often, and why you take each of your medications in your wallet or on your phone.

-Don’t take over-the-counter medicine, vitamins, or supplements without checking first with your doctor or pharmacist. Medications to AVOID include: Anti-inflammatory medications like ibuprofen (Advil™, Motrin™) or naproxen (Aleve™), Decongestant pills (“cold & sinus”) that include pseudoephedrine or phenylephrine, Acetylsalicylic acid (Aspirin), except for the 81-mg dose if prescribed or recommended by your healthcare team.

Know what side effects to watch out for and discuss them with your healthcare provider in a timely fashion.

-Be patient and understand that it may take time for your body to adapt to certain medications.

-If you are not sure what to do with your medications when dehydrated, ask your healthcare team about sick day management of your medications.

-Try to be consistent with the time of day that you take your medication. Timing when you take your medication with another activity that you do at the same time every day, such as brushing your teeth, can be helpful.

-Keep a list of everyone on your heart failure team (doctors, pharmacists, peer support, caregivers) and carry it with you to appointments.

-Notify your healthcare team if any changes are made to your medicines by a different provider.

Glossary of Terms

Adrenaline

Also known as “epinephrine”, this is a chemical messenger that controls the sympathetic nervous system and causes the "fight or flight" response.

Contraindication

Anything (i.e., a symptom or medical condition) that is a reason for a person to not receive a particular treatment or procedure because it may be harmful.

Diuretics

Diuretics (commonly called ‘water pills’) rid the body of excess fluid, help to reduce swelling and bloating and make it easier to breathe.

Echocardiogram

An echocardiogram (ECHO) is an ultrasound of the heart that shows details of the heart’s structure and function.

Guideline-directed medical therapy (GDMT)

Wherever possible, CCS/CHFS Heart Failure Guidelines recommend that people with HFrEF be treated with 4 different types of medications early after diagnosis. This combination of medications is known as GDMT.