Guideline-Directed Medical Therapy for the Treatment of Heart Failure with Reduced Ejection Fraction. [Review]

MedStar author(s):
Citation: Drugs. 83(9):747-759, 2023 Jun.PMID: 37254024Institution: MedStar Heart & Vascular Institute | MedStar Washington Hospital CenterDepartment: Cardiovascular Disease FellowshipForm of publication: Journal ArticleMedline article type(s): Journal Article | ReviewSubject headings: *Diabetes Mellitus, Type 2 | *Heart Failure | *Sodium-Glucose Transporter 2 Inhibitors | Adrenergic beta-Antagonists/pd [Pharmacology] | Adrenergic beta-Antagonists/tu [Therapeutic Use] | Angiotensin Receptor Antagonists/pd [Pharmacology] | Angiotensin Receptor Antagonists/tu [Therapeutic Use] | Angiotensin-Converting Enzyme Inhibitors/pd [Pharmacology] | Angiotensin-Converting Enzyme Inhibitors/tu [Therapeutic Use] | Diabetes Mellitus, Type 2/dt [Drug Therapy] | Heart Failure/dt [Drug Therapy] | Humans | Sodium-Glucose Transporter 2 Inhibitors/tu [Therapeutic Use] | Stroke Volume | Year: 2023ISSN:
  • 0012-6667
Name of journal: DrugsAbstract: Guideline-directed medical therapy (GDMT) is the cornerstone of pharmacological therapy for patients with heart failure with reduced ejection fraction (HFrEF) and consists of the four main drug classes: renin-angiotensin system inhibitors, evidence-based beta-blockers, mineralocorticoid inhibitors and sodium glucose cotransporter 2 inhibitors. The recommendation for use of GDMT is based on the results of multiple major randomized controlled trials demonstrating improved clinical outcomes in patients with HFrEF who are maintained on this therapy. The effect is most beneficial when medications from the four main drug classes are used in conjunction. Despite this, there is an underutilization of GDMT, partially due to lack of awareness of how to safely and effectively initiate and titrate these medications. In this review article, we describe the different drug classes included in GDMT and offer an approach to initiation and effective titration in both the inpatient as well as outpatient setting. Copyright © 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.All authors: Ahmed A, Deedwania P, Fonarow GC, Lam PH, Patel J, Rassekh N, Sheikh FHFiscal year: FY2023Digital Object Identifier: Date added to catalog: 2023-07-27
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Journal Article MedStar Authors Catalog Article 37254024 Available 37254024

Guideline-directed medical therapy (GDMT) is the cornerstone of pharmacological therapy for patients with heart failure with reduced ejection fraction (HFrEF) and consists of the four main drug classes: renin-angiotensin system inhibitors, evidence-based beta-blockers, mineralocorticoid inhibitors and sodium glucose cotransporter 2 inhibitors. The recommendation for use of GDMT is based on the results of multiple major randomized controlled trials demonstrating improved clinical outcomes in patients with HFrEF who are maintained on this therapy. The effect is most beneficial when medications from the four main drug classes are used in conjunction. Despite this, there is an underutilization of GDMT, partially due to lack of awareness of how to safely and effectively initiate and titrate these medications. In this review article, we describe the different drug classes included in GDMT and offer an approach to initiation and effective titration in both the inpatient as well as outpatient setting. Copyright © 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.

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