Outpatient Medication Titration in Acute Heart Failure

  • Juan R. Vilaro
  • David E. Winchester
Part of the Contemporary Cardiology book series (CONCARD)


Outpatient management of heart failure has changed significantly over the past 20 years, with evolving concepts of what improves longevity, decreases hospitalizations, and improves functional capacity. Randomized controlled trials have established the efficacy of many medications in reducing morbidity and mortality in patients with heart failure: angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, beta-blockers (carvedilol, metoprolol succinate, and bisoprolol), aldosterone antagonists, sodium channel blockers, and neprilysin inhibitors. Despite these therapeutic options, patients are frequently undertreated, and appropriate medications are not titrated to evidence-based doses. A stepwise approach to initiation of heart failure medication and titration to therapeutic doses is recommended and can be guided by considering both the American College of Cardiology/American Heart Association (ACC/AHA) class and New York Heart Association (NYHA) functional class of the patient. Such an approach is outlined in this chapter.


Blood pressure Nausea Shortness of breath Drug interaction Heart failure Outpatient Defibrillator Medical therapy 


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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Department of Medicine, Division of Cardiovascular MedicineUniversity of FloridaGainesvilleUSA

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