| COPD |
Emphasis on prevention (e.g., vaccinations, smoking cessation). Consider preferential use of inhaled anticholinergics over beta-agonists pending definitive clinical trials. Early intervention in the setting of exacerbations of either disease. Multidisciplinary management with cardiology and pulmonary. Volume optimization may be particularly important in these patients. Preferential use of cardioselective beta-blockers (metoprolol succinate or bisoprolol) pending additional prospective trials
|
| Anemia |
Thorough evaluation and treatment of underlying cause(s) of anemia. Management of contributing factors such as renal insufficiency and diabetes. Broad application of erythropoietin stimulating agents in HFrEF is not supported by previous studies. Iron deficiency may represent a relevant treatment target.
|
| Diabetes mellitus |
Avoid diabetic therapies that have been associated with increased HF risk (e.g., TZDs, DPP-4 inhibitors). Careful monitoring for other diabetic agents (e.g., metformin) in the setting of HF decompensation and renal dysfunction. Preferential use of metformin may be reasonable pending prospective trials given observational data suggesting benefits for clinical outcomes.
|
| Renal dysfunction |
Appropriate initiation of ACE-inhibitors/ARBs and MRAs, as able, with careful clinical monitoring. Volume status may be a key target of intervention. Alternative loop diuretics (e.g., torsemide) may be indicated. Multidisciplinary management with cardiology and nephrology.
|
| Sleep disordered breathing |
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