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Uptitration and follow-up planner

A visit-by-visit ladder from the current doses to the guideline targets, with the safety labs and timings from ESC 2026 and its practical-guidance tables. A plan to review with the patient, not an order set.

The same values as in the patient editor in the header and on the other pages: change one here and it changes there.

Sex

Calculated 84 (CKD-EPI 2021)

Kidney stage: G2 (eGFR 60–89).

Rhythm of visits

Rapid uptitration is for patients in hospital or otherwise closely monitored.

ESC prefers simultaneous implementation; a conservative approach may be reserved for low eGFR, hypotension or hyperkalaemia.

  • plan: start · starts 10 mg o.d.
  • plan: start · starts 25 mg o.d.
  • plan: start · starts 49/51 mg b.i.d.
  • plan: start · starts 1.25 mg o.d.

  1. Today

    • StartDapagliflozin10 mg o.d.
    • StartSpironolactone25 mg o.d.
    • StartSacubitril/valsartan49/51 mg b.i.d.
    • StartBisoprolol1.25 mg o.d.

    At the visit: fluid balance and diuretic dose, genito-urinary infection, ketoacidosis risk factors; potassium, creatinine (halve the dose if eGFR falls by more than 30%); symptomatic hypotension, creatinine and potassium; heart rate (hold uptitration below the set floor), blood pressure, signs of congestion, body weight.

  2. Week 2

    • UptitrateSpironolactone25 mg o.d. → 50 mg o.d.
    • UptitrateSacubitril/valsartan49/51 mg b.i.d. → 97/103 mg b.i.d.
    • UptitrateBisoprolol1.25 mg o.d. → 2.5 mg o.d.
    • urea/BUN, creatinine, K+ (MRA: 1–2 weeks after the change)
    • urea/BUN, creatinine, K+ (ARNI: 1–2 weeks after the change)

    At the visit: potassium, creatinine (halve the dose if eGFR falls by more than 30%); symptomatic hypotension, creatinine and potassium; heart rate (hold uptitration below the set floor), blood pressure, signs of congestion, body weight.

  3. Week 4

    • UptitrateBisoprolol2.5 mg o.d. → 3.75 mg o.d.
    • urea/BUN, creatinine, K+ (MRA: 1–2 weeks after the change)
    • urea/BUN, creatinine, K+ (MRA: 1–2 weeks after reaching the final dose)
    • urea/BUN, creatinine, K+ (ARNI: 1–2 weeks after the change)
    • urea/BUN, creatinine, K+ (ARNI: 1–2 weeks after reaching the final dose)

    At the visit: heart rate (hold uptitration below the set floor), blood pressure, signs of congestion, body weight.

  4. Week 6

    • UptitrateBisoprolol3.75 mg o.d. → 5 mg o.d.

    At the visit: heart rate (hold uptitration below the set floor), blood pressure, signs of congestion, body weight.

  5. Week 8

    • UptitrateBisoprolol5 mg o.d. → 7.5 mg o.d.

    At the visit: heart rate (hold uptitration below the set floor), blood pressure, signs of congestion, body weight.

  6. Week 10

    • UptitrateBisoprolol7.5 mg o.d. → 10 mg o.d.

    At the visit: heart rate (hold uptitration below the set floor), blood pressure, signs of congestion, body weight.

  • Visits every 2 weeks: ESC recommends uptitration at least every 1–2 weeks (Class I, C); doses are doubled at not less than 2-week intervals unless the patient is closely monitored.
  • After the final titration: chemistry every 4–6 months, an ECG for QRS and rhythm, echocardiography with deterioration.