ICU · Cardiovascular

Heart failure guideline-directed medical therapy update: SGLT2, ARNI, and the four pillars

Also known as Heart failure GDMT · Guideline-directed medical therapy · SGLT2 inhibitors · ARNI · Four pillars of heart failure · Dapagliflozin · Empagliflozin

Heart failure with reduced EF (HFrEF): FOUR PILLARS of guideline-directed medical therapy (GDMT). (1) ARNI (sacubitril/valsartan) or ACEi/ARB. (2) Beta-blocker (bisoprolol, carvedilol, metoprolol succinate). (3) Mineralocorticoid receptor antagonist (MRA — spironolactone, eplerenone). (4) SGLT2 inhibitor (dapagliflozin, empagliflozin) — NEWEST, benefits HF regardless of diabetes. Each reduces mortality ~15-20%. Target: all four (if tolerated). New paradigm: start EARLY, all FOUR, then uptitrate. SGLT2 inhibitors are REVOLUTIONARY — first drug class to benefit HFrEF AND HFpEF. In ICU: don't start new GDMT during acute decompensation — stabilise first, start after recovery.