Table 3.

Management of chronic heart failure therapies during hospitalization.

Medication	Transition in Hospital	Monitoring
Diuretics	Continue or augment (if indicated), unless signs/symptoms of dehydration	Daily weight (standing) Strict intake and output Vital signs (BP, HR, RR, O2 saturation) including orthostatic BP, HR BUN, serum creatinine Serum potassium and magnesium
Beta blockers	Continue unless decompensation due to recent addition or dose increase (in which case reduce dose). Discontinue if significant hypotension, bradycardia, or overt cardiogenic shock.	BP and HR including orthostatic BP, HR
ACE inhibitors and ARBs	Continue, unless hypotension or acutely worsening renal function	BP and HR including orthostatic BP, HR Strict intake and output BUN, serum creatinine Serum potassium
MRAs	Continue unless K+ > 5.5 or CrCl < 30 mL/min	BP and HR including orthostatic BP, HR Strict intake and output BUN, serum creatinine Serum potassium
Digoxin	Continue unless acutely worsening renal function, significant bradycardia (HR < 45 bpm), or signs/symptoms of toxicity Note: half-life =36 hrs if normal renal function (minimum of 5-7 days to reach steady state post initiation or dose change)	HR Serum creatinine Serum potassium, magnesium, and calcium Serum digoxin concentration (at least 6 hrs post dose) if not recently obtained, change in renal function, or addition/removal of interacting medication
Hydralazine/ Isosorbide dinitrate	Continue unless significant hypotension	BP and HR including orthostatic BP, HR

ACE = angiotensin converting enzyme, ARBs = angiotensin receptor blockers, BP = blood pressure, BUN = blood urea nitrogen, CrCl = creatine clearance, HR = heart rate, K+ = potassium, MRAs = mineralocorticoid receptor antagonists, O2 = oxygen, RR = respiratory rate.