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HF Top Tips 4 Dec2011:Layout 1   9/1/12    09:15   Page 1                                                     NHS         ...
HF Top Tips 4 Dec2011:Layout 1       9/1/12   09:15    Page 32    Top Tips for GPs - TWO     Up-titration     1.     2.   ...
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Heart failure top tips for GPs - 2 - uptitration of drugs in heart failure

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One of a set of four heart failure top tips for GPs postcards. The full set is:
1 - diagnosis
2 - up-titration of drugs in heart failure
3 - managing heart failure patients
4 - a crash course in heart failure with preserved ejection fraction

Published in: Health & Medicine
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Heart failure top tips for GPs - 2 - uptitration of drugs in heart failure

  1. 1. HF Top Tips 4 Dec2011:Layout 1 9/1/12 09:15 Page 1 NHS NHS Improvement Heart Heart Failure CANCER Top Tips for GPs www.improvement.nhs.uk/ DIAGNOSTICS heart/heartfailure HEART LUNG STROKE
  2. 2. HF Top Tips 4 Dec2011:Layout 1 9/1/12 09:15 Page 32 Top Tips for GPs - TWO Up-titration 1. 2. 3. 4. Start with the lowest dose of beta-blocker and ACEI Increase every two weeks Check U/Es and blood pressure every two weeks NHS NHS Improvement Use a beta-blocker that is licensed for heart failure - bisoprolol, carvedilol or nebivolol Heart 5. Beta-blockers are safe in COPD 6. An increase in creatinine to 265 µmol per litre or no more than 50% above starting level is OK 7. If potassium rises above 5.5 half the ACE inhibitor; if over 6mmol then stop it 8. Dropping back a dose is far better than stopping 9. Low doses of beta-blocker and an ACE inhibitor together are better than one alone - every little helps! 10. If discharged from hospital and heart failure medication has been stopped then restart it as soon as reasonable

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