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Review
. 2024 Sep;29(5):1065-1077.
doi: 10.1007/s10741-024-10419-5. Epub 2024 Jul 22.

High-intensity care for GDMT titration

Jan Biegus  1 , Matteo Pagnesi  2 , Beth Davison  3   4   5 , Piotr Ponikowski  6 , Alexander Mebazaa  5   7 , Gadi Cotter  3   4   5
Affiliations
Review

High-intensity care for GDMT titration

Jan Biegus et al. Heart Fail Rev. 2024 Sep.

Abstract

Heart failure (HF) is a systemic disease associated with a high risk of morbidity, mortality, increased risk of hospitalizations, and low quality of life. Therefore, effective, systemic treatment strategies are necessary to mitigate these risks. In this manuscript, we emphasize the concept of high-intensity care to optimize guideline-directed medical therapy (GDMT) in HF patients. The document highlights the importance of achieving optimal recommended doses of GDMT medications, including beta-blockers, renin-angiotensin-aldosterone inhibitors, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter inhibitors to improve patient outcomes, achieve effective, sustainable decongestion, and improve patient quality of life. The document also discusses potential obstacles to GDMT optimization, such as clinical inertia, physiological limitations, comorbidities, non-adherence, and frailty. Lastly, it also attempts to provide possible future scenarios of high-intensive care that could improve patient outcomes.

Keywords: GDMT (guideline-directed medical therapy); GDMT optimization; Pharmacotherapy; Up-titration.

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Conflict of interest statement

J.B. has received honoraria from Bayer, Boehringer Ingelheim, and AstraZeneca for lectures. J.B. is also an associate Editor of the Heart Failure Reviews. M.P. has received personal fees from Abbott Laboratories, AstraZeneca, Boehringer Ingelheim and Vifor Pharma. MA has received speaker fees from Abbott Vascular and Medtronic. A.M. has received grants from Roche Diagnostics, Abbott Laboratories, 4TEEN4, and Windtree Therapeutics; honoraria for lectures from Roche Diagnostics, Bayer, and MSD; is a consultant for Corteria Pharmaceuticals, S-form Pharma, FIRE-1, Implicity, 4TEEN4, and Adrenomed; and is coinventor of a patent on combination therapy for patients having acute or persistent dyspnoea. P.P. reports personal fees from Boehringer Ingelheim, AstraZeneca, Servier, Bristol Myers Squibb, Amgen, Novartis, Merck, Pfizer, Berlin Chemie, and grants and personal fees from Vifor Pharma. G.C. is employee of Momentum Research, which has received grants for research from Abbott Laboratories, Amgen, Celyad, Cirius Therapeutics, Corteria Pharmaceuticals, Heart Initiative, Sanofi, Windtree Therapeutics, and XyloCor Therapeutics. G.C. is director of Heart Initiative, a non-profit organization. G.C. is also an associate Editor of the Heart Failure Reviews. B.D. is employee of Momentum Research, which has received grants for research from Abbott Laboratories, Amgen, Celyad, Cirius Therapeutics, Corteria Pharmaceuticals, Heart Initiative, Sanofi, Windtree Therapeutics, and XyloCor Therapeutics. B.D. is director of Heart Initiative, a non-profit organization. B.D. is also an associate Editor of the Heart Failure Reviews.

Figures

Fig. 1
Fig. 1
The proposed algorithm of GDMT optimization is based on a strong protocol
See this image and copyright information in PMC

References

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