304. Guidelines: 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure – Question #21 with Dr. Nancy Sweitzer

By CardioNerds - Last Updated: June 22, 2023

In this CardioNerds podcast: The CardioNerds, along with expert faculty Dr. Nancy Sweitzer (Washington University School of Medicine) reference Section 7.6 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure to answer the following question:

Ms. Smith is a 56-year-old woman following up in the cardiology clinic for a history of heart failure with reduced ejection fraction. Two years ago, she was diagnosed with non-ischemic cardiomyopathy with a left ventricular ejection fraction (LVEF) of 30%. Over time, she was initiated and optimized on guideline directed medical therapy. She is currently on Carvedilol 12.5 mg BID, Sacubitril/Valsartan 49/51 mg BID, Spironolactone 25 mg daily, Empagliflozin 10 mg daily, and Furosemide PRN for weight gain.

On today’s visit, her BP is 110/80 mmHg, and her HR is 67 bpm. Labs show a creatinine of 0.9 mg/dL, potassium of 5.1 mEq/L, NT-proBNP of 150 ng/L, and a HbA1c of 5.8%. Follow up transthoracic echocardiogram showed an improvement in LVEF to 55%. What are the most appropriate therapy recommendations for Ms. Smith?


Discontinue spironolactone


Discontinue empagliflozin


Decrease the dose of carvedilol


Continue current therapy

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