Ben DNP AGACNP-BC AACC HF-Cert

Interstitial fluid

My co-workers call me the "prince of pee" yesterday I lived up to my nickname diuresing 15 L off a patient 😆

#medsky #nursesky

I hope residency programs in family medicine, pediatrics, PA programs, and FNP programs in Florida really bulk up the lectures for diptheria, pertussis, polio, mumps, rubella, measels, and all the other vaccine-preventable illnesses so we can at least quarantine and treat the new outbreaks to come.

Just a PSA, going off your antihypertensives in favor of a more "natural" approach is a poor way to deal with HTN, but a great way to meet a heart failure specialist.

#medsky #nursesky

Spring in Seattle is gorgeous!

#pnw #Seattle #spaceneedle #mtranier

Just saying

This little monster is 3 today, love her so much!

#dogsky #pomsky #pomeraniansky

This furry gremlin is happy I'm home from work

#dogsky #pomeraniansky

Reading this amazing book about nursing history & current nurse leaders. All of my #nursesky friends should grab a copy.

#booksky

This medication is not intended to replace foundational GDMT, rather to be utilized in patients experiencing WHF to reduce the risk of CV death or HHF.

#medsky #cardiosky #nursesky

In the VICTORIA-HF trial there was reduction in cardiovascular death and hospitalization for HF.

But remember, WHF may not present solely in the hospital, clinic patients who present with volume overload requiring IV diuretics in the outpatient setting also should be considered.

For #hfweek2025 let's continue our discussion of WHF with a bit about vericiguat, a soluble guanylate cyclase stimulator. For patients who are experiencing WHF this medication has a class II indication in the current guidelines for the management of heart failure with a specific indication for WHF.

✔️ Consider addition of vericiguat based on VICTORIA-HF trial data to help reduce mortality

✔️ Referral to advanced heart failure

#medsky #nursesky #cardiosky

We must treat patients with WHF with the extreme urgency that their risk demands.

What can we do?

✔️ Rapid diuresis to relieve symptoms of congestion

✔️ Rapid multi-agent initiation of GDMT or optimization of existing agents

The #hfweek2025 topic today is risk for mortality associated with worsening heart failure. As demonstrated here in this graphic, patients with WHF are at a 40-60% risk of death, far higher than ASCVD risk and much higher than in many other disease processes.

✔️ Remember every touchpoint with a HF patient is an opportunity to evaluate their regimen and make adjustment

#medsky #nursesky #cardiosky @americanheart.bsky.social @accintouch.bsky.social @hfsa.bsky.social

✔️ Don't be paralyzed by fear of end-organ dysfunction, remember untreated or under-treated HF leads to end-organ failure and death
✔️ GDMT is proven safe and effective in these patients with multiple trials and large patient populations

What can we do?
✔️ Avoid delays in therapy - consider multiple agent initiation by starting more than 1 class concurrently
✔️ Initiate therapy when patients are hospitalized - patients who leave the hospital with appropriate therapy in hand are more likely to be adherent

Looking at data from the EVOLUTION-HF trial displayed here the majority of HF patients after 1 year of initiation of GDMT were on sub-optimal dosing (target dosing delineated by dark green).

Let's talk GDMT today for #hfweek2025. Foundational therapy is ARNI, SGLT2i, BB, & MRA at OPTIMAL doses.

GDMT saves lives:
‼️ Relative risk reduction 73%
‼️ Absolute risk reduction 26%
‼️ NNT = 3.9
‼️ Extending median survival 7-11 years

✔️ Remember every touchpoint with a HF patient is an opportunity to evaluate their regimen and make adjustment

#medsky #nursesky @accintouch.bsky.social @hfsa.bsky.social @thebhf.bsky.social @americanheart.bsky.social

✔️ Don't be paralyzed by fear of end-organ dysfunction, remember untreated or under-treated HF leads to end-organ failure and death
✔️ GDMT is proven safe and effective in these patients with multiple trials and large patient populations

What can we do?
✔️ Avoid delays in therapy - consider multiple agent initiation by starting more than 1 class concurrently
✔️ Initiate therapy when patients are hospitalized - patients who leave the hospital with appropriate therapy in hand are more likely to be adherent

Looking at data from the EVOLUTION-HF trial displayed here the majority of HF patients after 1 year of initiation of GDMT were on sub-optimal dosing (target dosing delineated by dark green).

I really can't stand him

We must work harder to address health disparities and to manage risk factors to prevent the development of heart failure and the progression of heart failure if it has developed.

#medsky #cardiosky #nursesky

Adults <45 are rising at the top of hospitalizations for heart failure, and are outpacing older adults in mortality. The southern US alone bears nearly 50% of the entire national burden. These younger adults are presenting with more co-morbid condition contributing to mortality.

As #hfweek2025 continues, some trends in epidemiology. Currently there are ~7 million adults with HF in the US, and projected to grow to 8.5 million by 2030. Mortality is rising again after years of decline.

Today kicks off #hfweek2025 with @hfsa.bsky.social

Hopefully my @accintouch.bsky.social colleagues join in spreading the word to increase visibility

We as a healthcare system have so much work to do for heart failure patients, but the best thing we can all do is commit to starting GDMT early!

Did you mean to say medial and scientific consensus?