Outpatient Medicine Update-CV Update

Video Transcription

Video Summary

The presentation reviews updated heart-failure classification, diagnosis, treatment, and emerging evidence through the case of a 72-year-old woman with edema, elevated BNP, iron deficiency, and an ejection fraction of 30–35% (HFrEF).

Heart failure stages range from risk factors without disease (A), to objective evidence without symptoms (B), symptomatic disease (C), and advanced disease (D). Ejection fraction further classifies patients as reduced (≤40%), improved (previously ≤40%, now >40%), mildly reduced (41–49%), or preserved (≥50%).

For HFrEF, guideline-directed therapy includes an ARNI, ACE inhibitor, or ARB; an evidence-based beta blocker; a mineralocorticoid receptor antagonist when kidney function and potassium allow; and an SGLT2 inhibitor. Use diuretics for congestion and titrate core therapies toward target doses promptly. SGLT2 inhibitors benefit patients across ejection-fraction groups, with evidence for fewer heart-failure hospitalizations and improved outcomes. In HFpEF, prioritize blood-pressure control, diuretics when congested, and SGLT2 inhibitors.

The lecture emphasizes that serial BNP testing should not guide diuretic adjustments in stable patients. IV iron can benefit iron-deficient patients with HFrEF, even without anemia; erythropoietin is not recommended for this case. Other promising approaches include rapid medication titration, remote hemodynamic monitoring, and weight-loss treatment for patients with obesity and HFpEF.

For the case patient, the answers are: <strong>BNP-guided diuretic dosing—false; erythropoietin—false; dapagliflozin reducing heart-failure events—true.</strong>

Keywords

heart failure

HFrEF

HFpEF

BNP

ejection fraction

SGLT2 inhibitors

ARNI

beta blocker

diuretics

iron deficiency

dapagliflozin