title: Heart Failure Update: Outpatient Management.
abstract: Outpatient management of heart failure (HF) is aimed at treating symptoms and preventing hospitalizations and readmissions. Management is initiated in a stepwise approach. Blockade of the renin-angiotensin system is a cornerstone of therapy and should be started, along with beta blockers, as soon as the diagnosis of HF is made. Other drugs, including diuretics, aldosterone antagonists, hydralazine, and nitrates, may be added based on symptoms and American College of Cardiology/American Heart Association stage. Despite a great interest in and theoretical benefit of naturoceutical products in the mitigation of oxidative stress and HF progression, none has been proven to be beneficial, and concerns exist regarding their interactions with standard HF drugs. Other nonpharmacologic interventions, including sodium restriction, regular exercise, and/or cardiac rehabilitation, should be initiated at diagnosis. HF often is progressive, and clinicians should be aware of late stage management options, including implantable devices, cardiac transplantation, and hospice care.
authors.affiliation: University of South Florida Bayfront Health Medical Center, 603 Seventh Street South Suite 440, St. Petersburg, FL 33701.
authors.forename: Katherine
authors.initials: K
authors.lastname: Wojnowich
authors.affiliation: University of South Florida Bayfront Health Medical Center, 625 Sixth Avenue South Suite 430, St. Petersburg, FL 33701.
authors.forename: Ravi
authors.initials: R
authors.lastname: Korabathina
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000553:Ambulatory Care / Q000379:methods; D000613:Aminobutyrates / Q000627:therapeutic use; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001552:Benzazepines / Q000627:therapeutic use; D001713:Biphenyl Compounds; D058406:Cardiac Resynchronization Therapy; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D002317:Cardiovascular Agents / Q000627:therapeutic use; D004039:Diet, Sodium-Restricted; D004077:Digoxin / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use*; D004338:Drug Combinations; D005081:Exercise Therapy; D015525:Fatty Acids, Omega-3 / Q000627:therapeutic use*; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D016027:Heart Transplantation; D017051:Hospice Care; D006801:Humans; D000077550:Ivabradine; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D013777:Tetrazoles / Q000627:therapeutic use; D000068756:Valsartan; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D000319:Adrenergic beta-Antagonists; D000613:Aminobutyrates; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D001552:Benzazepines; D001713:Biphenyl Compounds; D002316:Cardiotonic Agents; D002317:Cardiovascular Agents; D004232:Diuretics; D004338:Drug Combinations; D015525:Fatty Acids, Omega-3; D000451:Mineralocorticoid Receptor Antagonists; D013777:Tetrazoles; D014665:Vasodilator Agents; D000077550:Ivabradine; D004077:Digoxin; D000068756:Valsartan; C549068:sacubitril and valsartan sodium hydrate drug combination