From the Guidelines
Guideline-directed medical therapy (GDMT) consists of four main medication classes: beta-blockers, renin-angiotensin-aldosterone system (RAAS) agents, mineralocorticoid receptor antagonists (MRAs), and sodium-glucose co-transporter 2 (SGLT2) inhibitors. These classes are crucial in managing heart failure with reduced ejection fraction (HFrEF) and have a significant impact on reducing mortality and hospitalizations.
Key Medication Classes
- Beta-blockers: include carvedilol, metoprolol succinate, and bisoprolol, which help reduce sympathetic overactivity 1.
- RAAS agents: include ACE inhibitors, ARBs, and ARNIs, such as lisinopril, losartan, and sacubitril/valsartan, which target neurohormonal activation 1.
- MRAs: include spironolactone and eplerenone, which counteract aldosterone effects 1.
- SGLT2 inhibitors: include dapagliflozin and empagliflozin, which address metabolic dysfunction in heart failure 1.
Importance of GDMT
The use of GDMT has been shown to significantly improve outcomes in patients with HFrEF, with an estimated extension of life by over 6 years in a 55-year-old patient and by over a year in octogenarians 1.
Clinical Implications
Despite the benefits of GDMT, patients with HFrEF often do not receive these medications or receive them at suboptimal doses, leading to significant gaps in care 1. The comprehensive use of GDMT, including all four medication classes, is essential for optimizing outcomes in patients with HFrEF. This approach can help reduce mortality and hospitalizations, improve quality of life, and address the complex pathophysiological mechanisms involved in heart failure 1.
From the Research
GDMT Classes
The main GDMT classes for the treatment of heart failure with reduced ejection fraction (HFrEF) are:
- Renin-angiotensin system inhibitors 2
- Evidence-based β-blockers 2
- Mineralocorticoid inhibitors 2
- Sodium glucose cotransporter 2 inhibitors 2
Specific Medications
Some specific medications that are part of these classes include:
- Angiotensin-converting enzyme inhibitors (ACE-I) 3, 4, 5
- Angiotensin receptor blockers (ARB) 3, 4, 5
- Angiotensin receptor neprilysin inhibitors (ARNI) 5
- Beta blockers (BB) 3, 4, 5
- Mineralocorticoid receptor antagonists (MRAs) 5
- Furosemide 3
Tolerability and Intolerances
The tolerability of these medications can vary, with some patients experiencing intolerances such as: