From the Research
Guided Device-Based Meditation Therapy (GDMT) should not be considered as a replacement for Guideline-Directed Medical Therapy (GDMT) in Heart Failure with Reduced Ejection Fraction (HFrEF), and instead, GDMT should be initiated as soon as possible after diagnosis, ideally within days of confirming HFrEF, as it has been shown to reduce symptoms, prevent disease progression, and improve survival 1. When considering the initiation of GDMT in HFrEF, it is essential to prioritize the use of evidence-based medical therapies, including renin-angiotensin system inhibitors, beta-blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter 2 inhibitors, as they have been consistently shown to improve outcomes in HFrEF patients 2, 3, 4, 5. The current evidence suggests that the use of GDMT, including ACE inhibitors, beta-blockers, and mineralocorticoid receptor antagonists, should be initiated promptly, with careful monitoring of blood pressure, renal function, and electrolytes during initiation and dose titration 2, 3, 4, 5. While GDMT has been shown to be effective in reducing symptoms and improving quality of life in patients with HFrEF, its role as a primary treatment for HFrEF is not supported by the current evidence, and instead, it should be considered as an adjunctive therapy to GDMT 1. In terms of specific medications, the use of ACE inhibitors, such as lisinopril, beta-blockers, such as metoprolol succinate, and mineralocorticoid receptor antagonists, such as spironolactone, should be initiated at low doses and titrated upward every 2-4 weeks as tolerated to target doses 3, 4, 5. Additionally, the use of ARNI, such as sacubitril/valsartan, should be considered in place of ACE inhibitors after hemodynamic stability is achieved, typically within 4-6 weeks, and SGLT2 inhibitors, such as dapagliflozin or empagliflozin, should be considered for additional benefits, regardless of diabetes status 1, 3, 4, 5. Overall, the initiation of GDMT in HFrEF should be guided by the principles of evidence-based medicine, with a focus on reducing symptoms, preventing disease progression, and improving survival, and GDMT should not be considered as a replacement for GDMT in the treatment of HFrEF.