Before discharge — start all four foundational drugs (EF below 50%), titrate within 6 weeks: Sacubitril-valsartan, Bisoprolol, Spironolactone, Dapagliflozin
Advice and when to refer
Review: In 1–2 wk: potassium, creatinine, BP, weight; step doses up every 1–2 wk (ESC 2026; STRONG-HF)
Investigations
First visit
ECG — Arrhythmia or MI as the cause.
Chest X-ray — Pulmonary oedema and other causes of breathlessness.
Troponin, NT-proBNP or BNP — Supports heart failure; rule-out NT-proBNP under 300 pg/mL.
CBC, creatinine, electrolytes, blood glucose, LFT — Baseline before diuretics.
SpO₂ / blood gas — Severity.
Only if indicated
Echocardiography — Within 48 h (ejection fraction, valves); at once if shock.
TSH, iron studies — New heart failure.
Follow-up and monitoring
Creatinine and potassium — Daily while on IV diuretics; within 1–2 weeks of each dose step of ARNI/MRA.
Daily weight and urine output — Decongestion.
Locked
The adult dose for each drug
Indian brand names for each drug, with a link to buy
ICU Decoded — original critical-care and internal-medicine pathways by
Dr Javed Akhtar, each cited to a current guideline. For education and quick
reference; verify every dose against local protocols before prescribing.