Titration to maximum tolerated doses of ACE inhibitors (ACEIs), Angiotensin receptor blockers (ARBs), beta-blockers and mineralocorticoid receptor antagonists (MRAs) is recommended to reduce morbidity and mortality in left ventricular systolic HF.
Titration of medicines can be challenging as individuals with HF frequently have multiple co-morbidities, numerous medications and often move between acute and primary health-care sectors.
Other difficulties that may impact upon titration include:
- Lack of a clear, patient-specific titration plan
- Poor communication of medication plan between acute and primary care
- Difficulty in managing adverse effects associated with increasing doses
- Patient adherence issues due to the changing medication regimen
Nursing and pharmacy support can play an important role in enhancing treatment by supporting patient adherence and optimising evidence-based treatment by using tools such as a Heart failure medication titration plan. Medication titration plans should be completed by the patient’s treating healthcare team and outline a suggested schedule of titration, target doses for HF medicines, required monitoring, and management of common adverse effects.