SIMULTANEOUS OR RAPID SEQUENCE INITIATION OF QUADRUPLE MEDICAL THERAPY FOR HEART FAILURE—OPTIMIZING THERAPY WITH THE NEED FOR SPEED

Duke Clinical Research Institute; Duke University School of Medicine; University of Mississippi Medical Center; Ahmanson-UCLA Cardiomyopathy Center

Many eligible patients with heart failure with reduced ejection fraction (HFrEF) do not receive timely therapies that can extend survival. Recent advancements in pharmacotherapy highlight the need for a change in treatment practices. The document presents evidence supporting the simultaneous or rapid initiation of quadruple therapy, which includes an angiotensin receptor-neprilysin inhibitor (ARNI), a beta-blocker, a mineralocorticoid receptor antagonist (MRA), and a sodium-glucose cotransporter 2 inhibitor (SGLT2i). This approach is shown to significantly reduce mortality and hospitalization rates shortly after initiation.