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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Greene SJ, Butler J, Fonarow GC. Simultaneous or Rapid Sequence Initiation of Quadruple Medical Therapy for Heart Failure—Optimizing Therapy With the Need for Speed. JAMA Cardiol. Published online March 31, 2021. doi:10.1001/jamacardio.2021.0496
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