Heart failure medications save lives. The pillars of optimal heart failure medications are
beta-blocker
ACE inhibitor or angiotensin receptor blocker
mineralocorticoid antagonist (spironolactone or eplerenone)
sacubitril
empagliflozin
Other therapies to consider
IV iron replacement for iron deficiency (Ferritin <100mcg/L)
AF ablation for atrial fibrillation
CPAP for OSA
Devices - CRT, ICD
Over 36 months,
NNT for ACEi/ARB is 26;
NNT for beta-blocker is 9;
NNT for mineralocorticoid receptor antagonists is 6.
Dosages are important though, and many patients may not be on sufficient dosages. Here is a a summary, adapted from ACC/AHA guidelines.
ACEi
Captopril 6.25mg to 50mg TDS (122.7mg/d in trials)
Enalapril 2.5mg to 10-20mg BD (16.6mg/d in trials)
Lisinopril 2.5-5mg to 20-40mg OD (32.5-35mg/d in trials)
Perindopril 2mg to 8-16mg OD
ARBs
Candesartan 4-8mg to 32mg OD (24mg/d in trials)
Losartan 25-50mg to 50-150mg OD (129mg/d in trials)
Valsartan 20-40mg to 160mg BD (254mg/d in trials)
Beta-blockers
Bisoprolol 1.25mg to 10mg OD (8.6mg/d in trials)
Carvedilol 3.125mg to 50mg BD (37mg/d in trials)
Metoprolol CR 23.75 to 195mg OD (159mg/d in trials)
Aldosterone antagonists
Spironolactone 12.5-25mg OD to 25mg OD/BD (26mg/d in trials)
Eplerenone 25-50mg OD (42.6mg/d in trials)
Diuretics
Frusemide 40mg to 500mg
Bumetanide 1mg to 10mg (Bumetanide 1mg roughly corresponds to Frusemide 40mg)
Hydrochlorothiazide 25mg
Chlorthalidone 12.5-25mg
Metalazone 2.5mg
Amiloride 5mg
Sacubitril
Sacubitril / Valsartan 24/26 BD to 97/103 BD
Empagliflozin
Empagliflozin 10mg to 25mg OD
