[Skip to Navigation]
Views 9,228
Citations 0
Viewpoint
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. Published online March 31, 2021. 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).

Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    ×