Optimisation of diuretic and angiotensin receptor neprilysin inhibitor (ARNI) therapy in a patient with stage D heart failure

Introduction: Heart failure is a mojor public health problem with negative impact among patients through, altering their physical and mental status, and is also an important contributor to both the burden and cost of national healthcare expenditures. When heart failure is not treated properly, the quality of life decreases and implicitly increases the risk of death. Reducing clinical and subclinical congestion by administering the appro-priate medication is the basis for lowering the rate of hospitalization in patients with chronic heart failure.

Objective: To highlight the importance of diurethic and angiotensin receptor neprilysin inhibitor (ARNI) therapy in patients with stage D heart failure.

Methods: In this paper we will focus on importance of modulating diuretic and angiotensin receptor neprily-sin inhibitor (ARNI) therapy in an appropriate timing with past medical history of cardiovascular patology with appropriate treatment, was admitted for shortness of breath and orthopnea. Worsening of classical symp-toms of heart failure accompanied by decreased cardiac output, and implicitly of its consequences on the whole body in a patient with the average dose of ARNI and iv diuretics therapy raised a question mark over the the-rapeutic course of our patient. Through increasing diu-rectic therapy and reducing ARNI strengh to half dose, the patient’s symptomathology improved significantly. Results: Heart failure is the final stage of evolution of many cardiac diseases, a stage in which our patient is. Patient is known with multiple cardiovascular patho-logy compliant with ambulatory treatment- based on ESC guidelines for heart failure, however, he has was admitted for congestive heartfailure symptomathology. After reducing the ARNI dose from 49/51 mg x 2 / day to 24/26 mg x 2 / day and supplementing with 10 mg of torasemide added to the initial 60 mg furosemide and cessation of spironolactone due to hyperkalaemia and renal impairment, symptomatology of the patient was clearly relieved, with the remittance of oedema and weight loss of about 10 kg since admission. Sub-sequently, after hemodynamic status improvement as well as restoration of renal function, the initial dose of ARNI was restored, iv / po furosemide was discontinu-ed instead was discharged with 10 mg torasemide and spironolactone was reintroduced, a medication with hemodynamically important impact for our patient.

Conclusions: Improvement of symptomatology and functional capacity in a patient with multiple cardio-vascular pathology, compliant to home treatment by modulation of the initially administered therapy, has had a profound importance on our patient. The op-timization of the treatment in a patient with stage D heart failure is a situation that has a positive impact on the patient. Optimisation of the treatment in the right time in a stage D heart failure patient could prevent a potentially fata event for the patient.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)