From the Guidelines
The primary medications used in goal-directed medical therapy for Heart Failure (HF) are beta-blockers, renin-angiotensin-aldosterone system (RAAS) agents, mineralocorticoid receptor antagonists (MRAs), and sodium-glucose co-transporter 2 (SGLT2) inhibitors.
Medications for HF
- Beta-blockers: proven to reduce mortality, recommended for all patients with current or prior symptoms of HFrEF, unless contraindicated 1
- RAAS agents: recommended for symptomatic patients with HFrEF to reduce the risk of HF hospitalization and death 1
- MRAs: recommended for patients with HFrEF who remain symptomatic despite treatment with an ACE-I and a beta-blocker 1
- SGLT2 inhibitors: estimated to prevent 34,000 deaths in the United States annually, recommended for use in patients with HFrEF without contraindication 1
Key Considerations
- These medications have a Class 1 recommendation for use in patients with HFrEF without contraindication 1
- Quadruple medical therapy for HFrEF is estimated to reduce the risk of death by 73% over 2 years, and extend life expectancy by 6 years for a 55-year-old patient 1
- Optimal use of these medications can prevent thousands of deaths annually, but gaps in use and dosing remain a significant issue 1
From the Research
Medications Used in Goal-Directed Medical Therapy for Heart Failure
The following medications are used in goal-directed medical therapy for Heart Failure (HF):
- Renin-angiotensin system inhibitors 2
- Evidence-based β-blockers 2, 3, 4, 5
- Mineralocorticoid inhibitors 2, 3, 4, 5, 6
- Sodium glucose cotransporter 2 inhibitors 2, 6
- Angiotensin receptor neprilysin inhibitors 5, 6
Usage of Guideline-Directed Medical Therapy
The usage of guideline-directed medical therapy (GDMT) in the treatment of heart failure (HF) has shown to reduce morbidity and mortality 3. However, the use of GDMT at recommended doses remains suboptimal 5. Studies have shown that patients who are managed in HF clinics receive GDMT and target doses of disease-modifying drugs (DMD) when compared to those treated in other general cardiology outpatient departments (OPD's) 3, 4.
Optimization of Guideline-Directed Medical Therapy
Optimization of GDMT in acute HF is feasible and associated with improved 30-day hospitalization-free survival and 1-year survival 5. Inpatient use of GDMT during HF hospitalizations is critical, and discharge GDMT rates are low 6. Factors associated with inpatient GDMT use and predischarge discontinuation include inpatient hypotension, hyperkalemia, and worsening renal function 6.