#135 Guideline Directed Medical Therapy Part II: 5 Pearls Segment

Guideline-Directed Medical Therapy (GDMT) in Heart Failure with Reduced Ejection Fraction

Guideline-Directed Medical Therapy (GDMT) for heart failure with reduced ejection fraction is discussed in this podcast episode. GDMT consists of four pillars of therapy: beta blockers, ACE inhibitors, ARBs or ARNIs, mineralocorticoid receptor antagonists (MRA), and SGLT2 inhibitors. The first main point emphasizes the importance of starting, continuing, or stopping GDMT medications in patients with progressive chronic kidney disease (CKD). The second point focuses on the use of hydralazine and isosorbide dinitrate as additional agents for vasodilation in patients who are already on max tolerated doses of other GDMT medications. The third point highlights the use of ivabradine as an adjunctive agent to further lower heart rate in patients already on optimal doses of beta blockers. The fourth point discusses the benefits and considerations of initiating GDMT in the inpatient setting versus the outpatient setting. Finally, the fifth point explores whether GDMT should be continued even after a patient's ejection fraction has improved, highlighting the importance of long-term cardioprotective medications for reducing the risk of recurrent left ventricular dysfunction and heart failure events.