Review

The ABCs of managing systolic heart failure: Past, present, and future

Ike S. Okwuosa, MD, Oluseyi Princewill, MD, MPH, Chiemeke Nwabueze, MD, Lena Mathews, MD, Steven Hsu, MD, Nisha A. Gilotra, MD, Sabra Lewsey, MD, MPH, Roger S. Blumenthal, MD and Stuart D. Russell, MD
Cleveland Clinic Journal of Medicine October 2016, 83 (10) 753-765; DOI: https://doi.org/10.3949/ccjm.83a.16006

Article Figures & Data

Figures

Tables

  • TABLE 1

    Heart failure stages and functional classes

    NYHA class I
    No physical limitations    		NYHA class II
    Slight limitation of physical activity    		NYHA class III
    Marked limitation of physical activity    		NYHA class IV
    Symptoms at rest
    Stage A
    Patients at risk for heart failure
    No structural disease    		Stage B
    Structural disease
    No heart failure symptoms    		Stage C
    Structural disease
    Heart failure symptoms    		Stage D
    End-stage disease

    • NYHA = New York Heart Association

  • TABLE 2

    Angiotensin-converting enzyme inhibitors for managing heart failure

    Generic nameDosing range
    Benazepril5–40 mg once a day
    Captopril6.5–50 mg three times a day
    Enalapril2.5–20 mg twice a day
    Fosinopril5–40 mg once a day
    Lisinopril2.5–40 mg once a day
    Quinapril5–20 mg once a day
    Ramipril1.25–10 mg once a day
    Trandolapril1–4 mg once a day
  • TABLE 3

    Angiotensin II receptor blockers for managing heart failure

    Generic nameDosing range
    Candesartan4–32 mg once a day
    Losartan25–150 mg once a day
    Valsartan20–160 mg twice a day
  • TABLE 4

    Aldosterone receptor antagonists for managing heart failure

    Generic nameDosing range
    Eplerenone25–50 mg once a day
    Spironolactone12.5–25 mg once or twice a day
  • TABLE 5

    Angiotensin-neprilysin inhibition for managing heart failure

    Generic nameDosing range
    Sacubitril-valsartan24–26 mg, 49–51 mg, or 97–103 mg twice daily
    If tolerated for 2–4 weeks, double the daily dose until target dose of 97–103 mg twice daily is reached
    For patients converting from an ACE inhibitor, this medication should be started 36 hours after discontinuation of the ACE inhibitor
  • TABLE 6

    Beta-blockers for managing heart failure

    Generic nameDosing range
    Bisoprolol1.25–10 mg once a day
    Carvedilol3.125–50 mg twice a day
    Metoprolol succinate12.5–200 mg once a day
  • TABLE 7

    If inhibition for managing heart failure

    Generic nameDosing range
    Ivabradine5–7.5 mg twice a day
    Initial dosing is 5 mg by mouth twice daily for 2 weeks
    Dose may be increased 5 mg to maintain a resting heart rate between 50 and 60 beats per minute
    Maximum daily dose 15 mg/day
  • TABLE 8

    Diuretic dosing in heart failure

    Generic nameDosing range
    Bumetanide0.5–10 mg daily in one or two doses
    Furosemide20–600 mg daily in one or two doses
    Torsemide10–200 mg once daily
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