We recommend n-3 PUFA therapy at a dose of 1g daily be considered for reduction in morbidity and CV mortality in patients with mild-to-severe HF and reduced EF. (Recommendation Strong, Quality Moderate).

Practical Tips

• In presence of significant renal dysfunction, higher doses or combination diuretic agents might be needed; blood work needs to be closely followed.
• Patients with recurrent fluid retention who are able to follow instructions can be taught to adjust their diuretic dose based on symptoms and changes in daily body weight.
• In patients receiving digoxin, serum potassium and creatinine should be measured with increases in digoxin or diuretic dose, addition or discontinuation of an interacting drug, or during a dehydrating illness, to reduce the risk of digoxin toxicity. Patients with reduced or fluctuating renal function, the elderly, those with low body weight, and women are at increased risk of digoxin toxicity and might require more frequent monitoring including digoxin levels.
• Nitrates alone can be useful to relieve dyspnea or angina but continuous use should generally be avoided because of the risk of development of tolerance.