#458 HFrEF: Heart Failure with Reduced Ejection Fraction

In this episode of The Curbsiders, Dr. Michelle Kittleson discusses heart failure with reduced ejection fraction (HFrEF). She emphasizes identifying the underlying cause of cardiomyopathy through tests for coronary artery disease, thyroid issues, diabetes, HIV, and hemochromatosis. Dr. Kittleson outlines the four pillars of guideline-directed medical therapy (GDMT): ARNI, beta-blockers, mineralocorticoid antagonists, and SGLT2 inhibitors, recommending a rapid sequence initiation, starting with ARNI, MRA, and SGLT2 inhibitors before introducing beta-blockers. She also addresses practical considerations such as medication costs and side effects, the importance of close patient follow-up, and lifestyle modifications like salt and water intake. Dr. Kittleson shares insights on defibrillators, cardiac resynchronization therapy, and secondary mitral regurgitation, as well as when to refer patients to a specialist using the "I Need Help" mnemonic.