From the Guidelines
When transitioning from heart failure with reduced ejection fraction (HFrEF) to heart failure with preserved ejection fraction (HFpEF), medications that primarily improve outcomes in HFrEF but lack evidence in HFpEF, such as beta-blockers, angiotensin receptor-neprilysin inhibitors, and ivabradine, may be considered for discontinuation, while SGLT2 inhibitors and mineralocorticoid receptor antagonists should be continued. The decision to discontinue certain medications should be individualized and made in consultation with a cardiologist, taking into account the patient's specific condition and medical history.
- Medications that should be considered for discontinuation include:
- Medications that should be continued include:
- SGLT2 inhibitors (like empagliflozin and dapagliflozin)
- Mineralocorticoid receptor antagonists (spironolactone or eplerenone) ACE inhibitors or ARBs may be continued if needed for other conditions like hypertension, as they have been shown to be beneficial in patients with HFpEF 1. The discontinuation process should be gradual to avoid rebound effects, particularly with beta-blockers which should be tapered over 1-2 weeks. It is essential to consider the patient's overall health and medical history when making decisions about medication discontinuation, and to prioritize their safety and well-being above all else. In general, the goal of treatment for HFpEF is to manage symptoms, slow disease progression, and improve quality of life, rather than to reverse the underlying condition 1. By carefully considering the patient's individual needs and medical history, healthcare providers can make informed decisions about medication discontinuation and develop an effective treatment plan for patients transitioning from HFrEF to HFpEF.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Medications to Discontinue in HFrEF to HFpEF Transition
There are no specific medications mentioned in the provided studies that should be discontinued when transitioning from Heart Failure with Reduced Ejection Fraction (HFrEF) to Heart Failure with Preserved Ejection Fraction (HFpEF).
Key Differences in HFrEF and HFpEF Management
- The management strategies for HFpEF and HFrEF have some key distinctions, although there is some overlap 2, 3, 4
- HFrEF treatment includes angiotensin-converting enzyme (ACE) inhibitors, angiotension receptor type 1 (AT1 ) antagonists, β-adrenoceptor antagonists, aldosterone receptor antagonists, diuretics, digoxin, and a combination drug with AT1 receptor antagonist and neprilysin inhibitor 5
- HFpEF treatment is largely focused on management of symptoms and comorbidities, with no approved treatments specifically indicated for HFpEF 2, 3
Considerations for Medication Use in HFpEF
- Ivabradine, a blocker of an I funny current (I(f)) channel, is used to lower heart rate in HFrEF, but its effect on HFpEF is less consistent 6, 5
- Sacubitril/valsartan is used in HFrEF, but its use in HFpEF is not well established 6
- The use of medications such as ivabradine and sacubitril/valsartan in HFpEF patients should be carefully considered, as their effectiveness and safety in this population are not well established 6, 5