Beta-blocker, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, nitrate-hydralazine, diuretics, aldosterone antagonist, ivabradine, devices and digoxin (BANDAID2): an evidence-based mnemonic for the treatment of systolic heart failure

Abstract

Heart failure causes significant morbidity and mortality, with recognised underutilisation rates of guideline based therapies. Our aim was to review current evidence for heart failure treatments and derive a mnemonic summarising best practice which might assist physicians in patient care. Treatments were identified for review from multinational society guidelines and recent randomised trials, with a primary aim of examining their effects in systolic heart failure patients on mortality, hospitalisation rates and symptoms. Secondary aims were to consider other clinical benefits. MEDLINE and EMBASE were searched using a structured keyword strategy and the retrieved articles were evaluated methodically to produce an optimised reference list for each treatment. We devised the mnemonic BANDAID2, standing for Beta-blocker, ACE inhibitor/ARB, Hydralazine-Isosorbide DiNitrate (or potentially Neprilysin inhibitor), Diuretics, Aldosterone antagonist, Ivabradine, Devices (AICD, CRT or both) and Digoxin as a representation of treatments with strong evidence for their use in systolic heart failure. Treatment with omega-3 fatty acids, statins or anti-thrombotic therapies has limited benefits in a general heart failure population. Adoption of this mnemonic for current evidence based treatments for heart failure may help improve prescribing rates and patient outcomes in this debilitating, high mortality condition.