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March 31, 2021

Simultaneous or Rapid Sequence Initiation of Quadruple Medical Therapy for Heart Failure—Optimizing Therapy With the Need for Speed

Author Affiliations
  • 1Duke Clinical Research Institute, Durham, North Carolina
  • 2Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
  • 3Department of Medicine, University of Mississippi Medical Center, Jackson
  • 4Ahmanson-UCLA Cardiomyopathy Center, University of California Los Angeles, Los Angeles
  • 5Associate Section Editor, JAMA Cardiology
JAMA Cardiol. 2021;6(7):743-744. doi:10.1001/jamacardio.2021.0496

Many eligible patients with heart failure (HF) with reduced ejection fraction (HFrEF) never receive therapies shown to extend survival or receive them with much delay.1,2 Multiple recent successes in pharmacotherapy for HFrEF provide impetus for embracing change in HFrEF treatment in clinical practice. Quadruple therapy with an angiotensin receptor–neprilsyin inhibitor (ARNI), evidence-based β-blocker, mineralocorticoid receptor antagonist (MRA), and sodium glucose cotransporter 2 inhibitor (SGLT2i) may reduce risk of death by 73% over 2 years.3 Herein, we present the case for simultaneous or rapid sequence initiation of these 4 lifesaving therapies (Figure).

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