From the Guidelines
Guideline-Directed Medical Therapy (GDMT) for Heart Failure with preserved Ejection Fraction (HFpEF) should include medications such as diuretics, ACE inhibitors, ARBs, and beta-blocking agents to control symptoms and comorbidities, as recommended by the 2013 ACCF/AHA guideline 1. The primary goal of GDMT in HFpEF is to alleviate symptoms, improve quality of life, and reduce morbidity and mortality.
- Diuretics are recommended for relief of symptoms due to volume overload, with a Class of Recommendation (COR) of I and a Level of Evidence (LOE) of C 1.
- ACE inhibitors, ARBs, and beta-blocking agents are suggested for hypertension management in HFpEF, with a COR of IIa and a LOE of C 1.
- Additionally, ARBs may be considered to decrease hospitalizations in HFpEF, with a COR of IIb and a LOE of B589 1. Key considerations in HFpEF management include:
- Controlling systolic and diastolic blood pressure according to published clinical practice guidelines, with a COR of I and a LOE of B27,91 1.
- Managing atrial fibrillation according to published clinical practice guidelines to improve symptomatic HF, with a COR of IIa and a LOE of C 1.
- Coronary revascularization for patients with CAD in whom angina or demonstrable myocardial ischemia is present despite GDMT, with a COR of IIa and a LOE of C 1.
From the Research
Medications for HFpEF
The provided studies do not directly address the medications that are part of Guideline-Directed Medical Therapy (GDMT) for Heart Failure with preserved Ejection Fraction (HFpEF). However, we can look at the information available for Heart Failure with reduced Ejection Fraction (HFrEF) and see if there are any implications for HFpEF.
GDMT for HFrEF
For HFrEF, the following medications are part of GDMT:
- Renin-angiotensin system inhibitors 2
- Evidence-based β-blockers 2
- Mineralocorticoid inhibitors 2
- Sodium glucose cotransporter 2 inhibitors 2
- Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or angiotensin receptor-neprilysin inhibitors (ACEi/ARB/ARNI) 3, 4
- Beta-blockers (BB) 3, 4
- Mineralocorticoid receptor antagonists (MRA) 3
- Vasodilators (for Black patients) 4
Implications for HFpEF
While the studies do not provide direct information on GDMT for HFpEF, one study mentions that beta-blockers are not recommended for the treatment of HFpEF according to the latest guidelines, but they are still commonly used for comorbidity management 5. Another study found that beta-blocker use was associated with a lower risk of the primary outcome in patients with HFmrEF or HFpEF 5.
Medications for HFpEF
Based on the available information, the following medication may be used in patients with HFpEF:
- Beta-blockers (for comorbidity management) 5
- Dapagliflozin (which has been shown to reduce the risk of clinical events in patients with HFpEF) 5
It is essential to note that these findings are not directly related to GDMT for HFpEF, and more research is needed to determine the most effective medications for this condition.