Treatment Protocol

SGLT2i can be beneficial in decreasing HF hospitalizations and cardiovascular mortality.

Use of evidence-based beta blockers for HFrEF, ARNi, ACEi, or ARB, and MRAs may be considered to reduce the risk of HF hospitalization and cardiovascular mortality, particularly among patients with LVEF on the lower end of this spectrum.

GDMT should be continued to prevent relapse of HF and LV dysfunction, even in patients who may become asymptomatic.

Should have medication titrated to attain blood pressure targets in accordance with published clinical practice guidelines to prevent morbidity.

SGLT2i can be beneficial in decreasing HF hospitalizations and cardiovascular mortality.

Management of AF can be useful to improve symptoms.

MRAs may be considered to decrease hospitalizations, particularly among patients with LVEF on the lower end of this spectrum.

The use of ARB may be considered to decrease hospitalizations, particularly among patients with LVEF on the lower end of this spectrum.

ARNi may be considered to decrease hospitalizations, particularly among patients with LVEF on the lower end of this spectrum.

Routine use of nitrates or phosphodiesterase-5 inhibitors to increase activity or QOL is ineffective.

When consistent with the patient’s goals of care, timely referral for HF specialty care is recommended to review HF management and assess suitability for advanced HF therapies (eg, LVAD, cardiac transplantation, palliative care, and palliative inotropes).

The benefit of fluid restriction to reduce congestive symptoms is uncertain.

Continuous intravenous inotropic support is reasonable as 'bridge therapy'.

Continuous intravenous inotropic support may be considered as palliative therapy for symptom control and improvement in functional status.

Long-term use of either continuous or intermittent intravenous inotropic agents, for reasons other than palliative care or as a bridge to advanced therapies, is potentially harmful.

Durable LVAD implantation is effective to improve functional status, QOL, and survival.

Durable MCS can be beneficial to improve symptoms, improve functional class, and reduce mortality.

Temporary MCS, including percutaneous and extracorporeal ventricular assist devices, are reasonable as a 'bridge to recovery' or 'bridge to decision'.

Cardiac transplantation is indicated to improve survival and QOL.