• Virani, S., Alonso, A., & Aparicio, H. (2021, January 27). Heart Disease and Stroke Statistics—2021 Update | Circulation . https://www.ahajournals.org/doi/10.1161/ CIR.0000000000000950 • Virani, S., Alonso, A., & Benjamin, E. J. (2020, October 1). Heart Disease and Stroke Statistics—2020 Update: A Report From the American Heart Association | Circulation . https://www.ahajournals.org/doi/10.1161/CIR.0000000000000757 • Wang, Z., Wang, W., Li, H., Zhang, A., Han, Y., Wang, J., & Hou, Y. (2021). Ivabradine and Atrial Fibrillation: A Meta-analysis of Randomized Controlled Trials. Journal of Cardiovascular Pharmacology . https://doi.org/10.1097/FJC.0000000000001209
• Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Colvin, M. M., Drazner, M. H., Filippatos, G. S., Fonarow, G. C., Givertz, M. M., Hollenberg, S. M., Lindenfeld, J., Masoudi, F. A., McBride, P. E., Peterson, P. N., Stevenson, L. W., & Westlake, C. (2017). 2017 ACC/ AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure. Journal of the American College of Cardiology , 70 (6), 776–803. https://doi. org/10.1016/j.jacc.2017.04.025
HEART FAILURE: EVIDENCE REVIEW AND MANAGEMENT Self-Assessment Answers and Rationales
1. The correct answer is D. Rationale: Carvedilol and lisinopril are considered core medi- cations that patients with HFrEF must be on due to mortality benefits. Spironolactone decreased mortality in the RALES trial. Therapy can be implemented in patients with an NYHA class II-IV provided potassium levels are less than 5mEq/L and have accept- able renal function. According to the DIG trial, digoxin improved symptoms and reduction in hospitalization, but not mortality.
2. The correct answer is D. Rationale: Currently, sacubitril/valsartan has the only FDA ap- proval for the treatment of HFpEF. Evidence in favor of this agent came after the ACC/AHA guidelines were published. Of the SGLT2 inhibitors, only empagliflozin currently has FDA break- through designation status but not FDA approval. Additionally, information on these agents was also made available after the HF guidelines were published.
HEART FAILURE: EVIDENCE REVIEW AND MANAGEMENT Final Examination Questions Select the best answer for each question and complete your test online at EliteLearning.com/Book
21. Which of the following definitions best describes heart failure with preserved ejection fraction? a. An ejection fraction of ≤ 40%. b. An ejection fraction of ≥ 50%. c. An ejection fraction between 41-49%. d. None of the above. 22. Which demographic has the highest prevalence of heart failure with preserved ejection fraction? a. Age greater than 65 years. b. African American males. c. Female gender. d. None of the above. 23. Which statement best describes the difference between the ACC/AHA staging system and the NYHA functional class system? a. The ACC/AHA scale is based on the presence of symptoms and cardiac structure abnormalities, while the NYHA is based on limitations in physical activity with severity progression. b. The ACC/AHA is based on limitations in physical activity with severity progression, while the NYHA class is based on the presence of symptoms and cardiac structure abnormalities. c. The ACC/AHA scale allows for bidirectional movement with patient improvement and worsening, while the NYHA class is unilateral only. d. There is no difference between the two systems, and they can be used interchangeabl y. 24. Which of the following statements accurately describe the pathophysiology of heart failure? a. The compensatory mechanism of heart failure enables the RAAS system to ultimately produce norepinephrine. b. Preload is the pressure at which the heart has to pump against. c. Afterload is referred to as the myocardial stretching prior to ventricular contraction. d. Increasing preload and afterload in patients with heart failure boosts stroke volume initially before reaching a plateau. 25. Which of the following statements is most accurate in diagnosing heart failure? a. Heart failure can be diagnosed exclusively on BNP. b. BNP helps to rule in a diagnosis because of the high sensitivity associated with the test. c. BNP and N- terminal- proBNP levels can be used interchangeabl y. d. A BNP level greater than 100 pg/mL may support a diagnosis of heart failure.
26. Based on ACC/AHA guidelines, which of the following agents should be used initially in patients with HFrEF unless contraindications exist? a. Carvedilol. b. Digoxin. c. Hydralazine/ Isosorbide dinitrate. d. Ivabradine 27. Which of the following statements is most accurate regarding SGLT2 inhibitors in the HFrEF setting? a. All SGLT2 inhibitors are created equal, and any should be used in the initial management of HFrEF. b. Robust data exists for SGLT2 inhibitors to significantly reduce cardiac mortality. c. Empagliflozin and dapagliflozin have the most evidence supporting the use in HFrEF. d. The ACC/AHA gives an 1/B recommendation to empagliflozin due to lack of improvement in HF-related hospitalization. 28. Which of the following recommendations is most accurate for the management of HFpEF? a. Robust data exists regarding mortality benefits with many drug classes. b. Guidelines recommend focusing on treating comorbid conditions and symptom management. c. Sildenafil is an I/A recommendatio n due to improvement in morbidity. d. Currently, dapagliflozin has FDA approval for the treatment of HFpEF. 29. Which of the following statements is true about digoxin? a. Robust data exists regarding mortality benefit for its use in heart failure. b. Drug concentration levels >1.2 ng/mL are associated with an increase in survival. c. Clinicians should target drug concentrations between 0.5-0.9 ng/mL in the HFrEF setting. d. It is considered a first-line agent for heart rate management due to the lack of significant drug interactions. 30. What is the best recommendation for a patient who experienced angioedema with lisinopril? a. The patient can try sacubitril/valsar tan after a 36- hour washout period. b. The patient can retry a different ACE inhibitor due to a lack of cross-sensitivity. c. The patient can try an angiotensin receptor blocker. d. The patient should immediately be changed to ivabradine. Course Code: RPUS02HM
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Book Code: RPUS3024
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