In this episode of Key Perspectives, we continue our heart failure series by diving into Part 3: Medication Management, with a focus on spironolactone, a cornerstone of guideline-directed medical therapy (GDMT).

We start by reviewing the distinctions between HFpEF, HFmrEF, and HFrEF, and discuss how treatment strategies differ across these subtypes. The hosts explain what GDMT is, who develops it, and why it's essential in improving outcomes and reducing hospitalizations in heart failure patients.

The spotlight is on spironolactone—its dual role in HFrEF and HFpEF, its mechanism as a mineralocorticoid receptor antagonist, and how it contributes to diuresis, cardiac remodeling prevention, and potassium-sparing benefits. We also cover clinical pearls, including when it can be used alongside loop diuretics like Lasix, and important considerations for avoiding use in patients with hyperkalemia or poor renal function.

Tune in for a concise, clinically relevant discussion that enhances your understanding of heart failure pharmacology and supports your practice in geriatric and complex patient care settings.

In this episode, we kick off our deep dive into heart failure treatment, starting with a fundamental goal: achieving ideal volume status. Managing fluid overload is crucial for symptom control and preventing hospitalizations — and today, we’re unpacking how to do it effectively.

We'll cover:

• Dry Weight: What it is, why it matters, and how to determine it.

• Fluid Restriction: When and why.

• Loop Diuretics: A comparison of the "Big 3" — Furosemide, Torsemide, and Bumetanide — including dosing strategies and absorption differences.

• Common Adverse Effects: Hypokalemia, renal function changes, and hypotension — what to monitor and how to respond.

• Potassium Supplementation: Should you start it preemptively when initiating a loop diuretic?

🔔 Stay tuned: In future episodes, we’ll continue walking through each major medication class used in heart failure management.

In this first installment of our multi-part series on Heart Failure (HF), we dive into why this condition deserves such focused attention—especially in older adults. Of the 5 million patients in the US that have heart failure, more than 75% of them are 65+. Understanding the nuances of this chronic, progressive disease is essential for clinicians in geriatric care.

Join us as we break down how to approach a patient with suspected heart failure, including key symptoms, diagnostic labs like BNP, and the role of imaging with echocardiography. We also explore the subtypes of HF—HFpEF, HFmrEF, and HFrEF—and discuss common communication pitfalls when discussing the diagnosis with patients.

Whether you’re in the clinic, at the bedside, or providing care via telemedicine, this episode lays the groundwork for confident, evidence-based heart failure management.