From the Guidelines
For a patient with a history of Heart Failure with Reduced Ejection Fraction (HFrEF) due to hyperthyroidism, who has achieved euthyroidism and an ejection fraction (EF) of 64% after treatment, Gadolinium (Gd) contrast media should not be continued as it is not a guideline-directed medical therapy (GDMT) for heart failure. Instead, the focus should be on continuing GDMT to prevent relapse of HF and left ventricular dysfunction, as recommended by the 2022 AHA/ACC/HFSA guideline for the management of heart failure 1. The patient's current EF of 64% indicates significant improvement, and the primary goal now is to maintain this recovery and prevent future cardiac decompensation. Key considerations in managing such a patient include:
- Monitoring for signs of heart failure recurrence
- Gradual tapering and discontinuation of medications under medical supervision, if applicable
- Continuing medications for other underlying cardiovascular conditions, if present
- Regular follow-up echocardiograms to ensure sustained cardiac recovery It's crucial to note that Gadolinium (Gd) contrast media is not typically used for the long-term management of heart failure, and its use should be limited to diagnostic purposes when necessary. The patient's treatment plan should be guided by the principles outlined in the 2022 AHA/ACC/HFSA guideline, which emphasizes the importance of continuing GDMT in patients with improved ejection fraction (HFimpEF) to prevent relapse and left ventricular dysfunction 1.
From the Research
Patient Considerations
- The patient has a history of Heart Failure with Reduced Ejection Fraction (HFrEF) due to hyperthyroidism, but has achieved euthyroidism and an ejection fraction (EF) of 64% after treatment.
- The use of Gadolinium (Gd) contrast media has been mentioned, but there is no direct evidence in the provided studies regarding the continued use of Gd in patients with HFrEF.
Guideline-Directed Medical Therapy (GDMT)
- GDMT is the cornerstone of pharmacological therapy for patients with HFrEF, consisting of four main drug classes: renin-angiotensin system inhibitors, evidence-based β-blockers, mineralocorticoid inhibitors, and sodium glucose cotransporter 2 inhibitors 2.
- The recommendation for use of GDMT is based on the results of multiple major randomized controlled trials demonstrating improved clinical outcomes in patients with HFrEF who are maintained on this therapy 2.
- GDMT use was higher in patients seen in an HF clinic, suggesting the potential benefit of referral to an HF clinic for patients with newly diagnosed HFrEF 3.
Treatment Adherence and Outcomes
- Heart failure hospitalization (HFH) represents an important opportunity to titrate GDMT among patients with HFrEF, and is positively associated with initiation and dose escalation of GDMT 4.
- De-escalation or discontinuation of GDMT after HFH is associated with increased risk of all-cause mortality, highlighting the importance of optimizing GDMT regimens 4.
- Treatment with beta-blockers and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitors is associated with a lower risk of death or HF hospitalizations in patients with severe HFrEF 5.
Conclusion Not Applicable
As per the provided instructions, a conclusion section is not applicable. The information provided is based on the available evidence and does not include personal opinions or advice. The decision to continue or discontinue the use of Gadolinium (Gd) contrast media in a patient with HFrEF should be made by a qualified healthcare professional, taking into account the individual patient's needs and medical history.