The following is a summary of “How do we define high and low dose intensity of heart failure medications: a scoping review,” published in the September 2023 issue of Cardiology by Kwak et al.
High-dose heart failure medications can cause adverse drug events in older adults. Current guidelines do not define high or low dose intensity, and there is no consensus. Researchers performed a retrospective study to define high and low-dose intensity heart failure medication in older adults.
They scoped the existing literature to identify the most commonly employed definition for distinguishing high versus low doses of heart failure medications. PubMed, Embase, CINAHL, and Cochrane Library were searched using comprehensive search terms designed to encompass the intensity of heart failure medications.
The results showed a review of 464 articles, encompassing various medications such as beta-blockers (BB), angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), diuretics, mineralocorticoid receptor antagonists (MRA), and angiotensin receptor-neprilysin inhibitor (ARNI). No eligible articles were found for hydralazine with isosorbide dinitrate or ivabradine. Among the identified 40 medications, consensus on dose intensity definitions was reached for most, except for nadolol, pindolol, cilazapril, and torsemide. Typically, according to guidelines, BBs, ACEis, or ARBs are defined as low as < 50% of the target dose and high as ≥ 50% of the target dose. For lisinopril and losartan, definitions of high and low doses were based on pre-defined criteria from pivotal clinical trials.
Investigators concluded that the scoping review identified the most frequently used definition of dose intensity for 40 medications but not for 4. Clinicians can use these results to guide medication monitoring and up-titration.