Management of Oral Therapy for Acute Heart Failure in the First 48h
| Hypotension | Low heart rate | Potassium | Renal impairment | ||||||
|---|---|---|---|---|---|---|---|---|---|
| Normotension/Hypertension | 85–100 mmHg | <85 mmHg | <60 ≥50/min | <50/min | ≤3.5 mg/dl | >5.5 mg/dl | Cr <2.5, eGFR >30 | Cr >2.5, eGFR <30 | |
| ACE-I/ARB | Review/Increase | Reduce/Stop | Stop | No change | No change | Review/Increase | Stop | Review | Stop |
| Beta blocker | No change | Reduce/Stop | Stop | Reduce | Stop | No change | No change | No change | No change |
| MRA | No change | No change | Stop | No change | No change | Review/Increase | Stop | Reduce | Stop |
| Diuretics | Increase | Reduce | Stop | No change | No change | Review/No change | Review/Increase | No change | Review |
| Other vasodilarors (nitrates) | Increase | Reduce/Stop | Stop | No change | No change | No change | No change | No change | No change |
| Other heart rate slowing drugs (amiodarone, CCB, Ivabradine) | Review | Reduce/Stop | Stop | Reduce/Stop | Stop | Review/Stop (*) | No change | No change | No change |
Legends: CCB, calcium channel blockers; Cr, creatinine blood level (mg/dl); eGFR, estimated glomerular filtration rate mL/min/1.73 m2; MRA, mineralocorticoid receptor antagonist; (*) amiodarone.
Source: Mebazaa A, Yilmaz MB, Levy P, et al. (2015) Recommendations on pre-hospital and early hospital management of acute heart failure: a consensus paper from the Heart Failure Association of the European Society of Cardiology, the European Society of Emergency Medicine and the Society of Academic Emergency Medicine. European Journal of Heart Failure 17, 544–558. Reproduced with permission of John Wiley & Sons.