Empagliflozin sick day plan

March 24, 2025 Andrew To

Empagliflozin is increasingly used in patients with heart failure, with or without diabetes.

Pharmac criteria for Empagliflozin for heart failure is in short include

Heart failure - NYHA II, III, IV
On optimal standard HF treatment
Echo - LVEF <= 40%; or if not practical

Ketoacidosis risk is real, however, and sick day plan may be useful

Sick day plan trigger =
- feel unwell (e.g. fever or stomach bug)
- cannot eat or drink normally
Sick day plan =
- Stop taking Empagliflozin
- Watch for sign of dehydration
- Restart after feeling better and eating/drinking normally for 2 days

We have a role in communicating such plan to patients on Empagliflozin, and is unique to the standard mix of heart failure patients.

Heart failure medications - dosages

February 17, 2024 Andrew To

Iris Iris Iris by Dane Mitchell @ Auckland Art Gallery 2019

Heart failure medications save lives.

Dosages are important though, and many patients may not be on sufficient dosages.

Here are a number of tables useful for references, adapted from ACC/AHA guidelines 2013.

Heart failure - Definitions

February 17, 2024 Andrew To

Twist, Bob, Spin by Jeff Thomson & Bev Goodwin @ Kaipara Coast Sculpture Gardens

Terminology can sometimes be confusing in heart failure care.

Here is a summary:

NYHA Class, HF stages, HFpEF vs. HFrEF

What should I do with heart failure with preserved ejection fraction?

September 7, 2019 Andrew To

HFpEF stands for heart failure with preserved ejection fraction. Commonly, it is defined as those with an LV ejection fraction of more than 50%, though varying definitions do exist.

This condition is poorly understood and is difficult to diagnose, because it is largely one of excluding other potential non cardiac causes of symptoms suggestive of HF.

NTproBNP - when should I actually order one?

September 6, 2019 Andrew To

NTproBNP is a very useful test in heart failure. However, often it is overused, as the diagnosis of heart failure should be a clinical one.

Here are the scenarios where it may be useful:

Beta-blockers in Hypertension

September 5, 2019 Andrew To

70-year-old asymptomatic man with hypertension but not cardiovascular disease presented for a routine check. His pulse rate was 40bpm. His son, aged 45, recently had an MI in Australia.

His medications include

Doxazosin 8mg OD
Metoprolol 95mg CR OD – since 2006
Cilazapril 5mg / Hydrochlorothiazide 12.5mg OD

ECG shows sinus bradycardia, with normal PR interval, QRS duration.