Cardionerds: A Cardiology Podcast 13. HF part 2: Approach to GDMT with Dr. Randall Starling
Feb 16, 2020
Dr. Randall Starling, former section head of Heart Failure at the Cleveland Clinic and past president of the Heart Failure Society of America, shares his expertise on guideline-directed medical therapy for heart failure. He discusses the critical role of beta blockers, the importance of personalized treatment approaches, and the challenges faced in diverse clinical trials. The conversation also touches on the emotional journeys of patients, the significance of education in treatment adherence, and the evolving landscape of heart failure medications.
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GDMT Is Broader Than Just Drugs
- Guideline-directed therapy includes more than medicines; it is comprehensive management and therapies.
- Dr. Randall Starling urges considering diagnosis, devices, and interventions alongside medications.
Make Beta Blockers And ARNI Priorities
- Prioritize beta blockers and aim to reach target doses because they most potently reverse remodeling.
- Start most HFrEF patients on sacubitril–valsartan (ARNI) unless clear contraindications exist.
Don't Underuse MRAs
- Routinely use mineralocorticoid receptor antagonists unless contraindicated and monitor potassium.
- Overcome hyperkalemia fear: MRAs remain underused in the US despite proven benefit.