How do you think the 4 pillar medications recommended in guidelines should be used ? one after the other ? The 4 together from the start ? - Heart Failure Forum https://heartfailurecongress.tmacademy.org/community/heart-failure-forum/how-do-you-think-the-4-pillar-medications-recommended-in-guidelines-should-be-used-one-after-the-other-the-4-together-from-the-start/ Heart Failure Congress 2024 Discussion Board en-US Wed, 09 Sep 2026 09:12:46 +0000 wpForo 60 Answer to: How do you think the 4 pillar medications recommended in guidelines should be used ? one after the other ? The 4 together from the start ? https://heartfailurecongress.tmacademy.org/community/heart-failure-forum/how-do-you-think-the-4-pillar-medications-recommended-in-guidelines-should-be-used-one-after-the-other-the-4-together-from-the-start/#post-11 Thu, 03 Aug 2023 19:06:42 +0000 I think the patient’s clinical state should determine how GDMT should be initiated. Two important factors will be the blood pressure and the patient’s eGFR. For example, if the patient has non-ischemic CMP with severe LV dysfunction and low-normal BP (e.g., 95/60mmHg), I won’t be in a hurry to initiate ARNI/ACEI/ARB. MRA and SGLT2i have less effect on BP in heart failure patients. I will also commence such patients on a low dose beta blocker, slowly titrated up. My approach will differ in a patient with better BP profile who has other contraindication to these 4 meds. For such, the 4 pillars can be initiated at a go. Of course, SGLT2i should not be prescribed in patients with very low eGFR or on dialysis. 

]]> Heart Failure Forum Rafiu Adefila https://heartfailurecongress.tmacademy.org/community/heart-failure-forum/how-do-you-think-the-4-pillar-medications-recommended-in-guidelines-should-be-used-one-after-the-other-the-4-together-from-the-start/#post-11 Answer to: How do you think the 4 pillar medications recommended in guidelines should be used ? one after the other ? The 4 together from the start ? https://heartfailurecongress.tmacademy.org/community/heart-failure-forum/how-do-you-think-the-4-pillar-medications-recommended-in-guidelines-should-be-used-one-after-the-other-the-4-together-from-the-start/#post-10 Wed, 12 Jul 2023 09:47:10 +0000 SHOULD BE USED ONE AFTER THE OTHER ACCORDING TO THE CLINICAL STAGE AND TESTING TOLERANCE AND CLINICAL RESPONSE 

]]> Heart Failure Forum PEDRO FORCADA https://heartfailurecongress.tmacademy.org/community/heart-failure-forum/how-do-you-think-the-4-pillar-medications-recommended-in-guidelines-should-be-used-one-after-the-other-the-4-together-from-the-start/#post-10 How do you think the 4 pillar medications recommended in guidelines should be used ? one after the other ? The 4 together from the start ? https://heartfailurecongress.tmacademy.org/community/heart-failure-forum/how-do-you-think-the-4-pillar-medications-recommended-in-guidelines-should-be-used-one-after-the-other-the-4-together-from-the-start/#post-3 Thu, 01 Jun 2023 11:02:00 +0000 Explain in detail. 

]]> Heart Failure Forum RytTrack https://heartfailurecongress.tmacademy.org/community/heart-failure-forum/how-do-you-think-the-4-pillar-medications-recommended-in-guidelines-should-be-used-one-after-the-other-the-4-together-from-the-start/#post-3