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Learn more about joining our team at jobs.miocllinic.org slash family medicine. Welcome to the American Family Physician Podcast for part one of the August 20 2025 issue. I'm Steve. I'm Rachel.

And I'm Kari. We are residents and faculty, mostly residents from the University of Arizona

College of Medicine Phoenix Family Medicine residency. Today on the podcast we're going to talk about

heart failure, lower GI bleeding, venous leg ulcers, non-opioid

pharmacologic management of chronic pain, resuscitation in burns, and ductal carcinoma in situ.

The opinions expressed in the podcast are our own and do not represent the opinions of the

American Academy of Family Physicians, the Editor of American Family Physician, or Banner Health. Do not use this podcast for medical advice. Instead, see your

own family doctor for medical care. Okay, let's start with heart failure, with reduced ejection

or HFREF medical management from doctors Gower, Raphat, and Falkrod from Womack Army Medical Center in North Carolina.

I like to call this section the E-Effectiveness of new therapies. Don't laugh at me.

That's terrible. I thought it was pretty clever. I love it. So we've all seen in treated

heart failure, inpatient and outpatient, but I always get a little nervous that

I'm not up to date. So here's the perfect refresh. Yes, so don't forget our tried and true

pillars of goal directed medical therapy or GDMT are still the same. Your first group is your

RAS inhibitors. RAS is the renin angiotensin-alodosterone system. And those are your Arneys, your ARBs, and your ACE inhibitors. RAS is the renin angiotensin aldosterone system, and those are your Arnees,

your ARBs, and your ACE inhibitors. Number two of your GDMT is your beta blockers. Three is your mineral

corticoid receptor antagonists, or we're going to call them MRIs, which includes spronylactone,

and then four is your SGL2 inhibitors. Okay, so say someone is newly

diagnosed with Hefreff, meaning their ejection fraction is less than 40%. What should be my next move?

...