In patients with heart failure (HF), the goals of treatment are to improve their clinical condition, functional capacity, quality of life, and to prevent the events of hospital readmissions and mortality. GDMT includes the following drug therapies: renin-angiotensin-aldosterone system inhibitors (RAAS-I), with or without a neprilysin inhibitor, β-blockers, and mineralocorticoid-receptor-antagonists (MRA).
Recently,
sodium-glucose cotransporter-2 inhibitors (SGLT2i) demonstrated efficacy as an
important fourth pillar of GDMT. Together, this combination can add over six
additional years of lifespan for HFrEF patients compared to the traditional
approach of RAAS-I and β-blockers alone. However, studies highlight that many
eligible HFrEF patients are not receiving one or more of the recommended
medications, in the absence of contraindications or intolerance. Even among
patients who are treated, less than half receive optimal doses of GDMT.
Additionally, time to initiation and optimization of dosing may be exceedingly
slow in the outpatient setting.
