Improving Guideline-Directed Medical Therapy for Patients with Heart Failure with Reduced Ejection Fraction: A Review of Implementation Strategies.

Abstract

Despite recent advances in guideline-directed medical therapy (GDMT) for patients with heart failure with reduced ejection fraction (HFrEF), achievement of target GDMT utilization and up-titration to goal doses continue to be modest. In recent years, a number of different interventional approaches to improve GDMT have been published, but many are limited by single-center experiences with small sample sizes. However, strategies including use of multidisciplinary teams, dedicated GDMT titration algorithms, and clinician audit with feedback have shown promise. There remains a critical need for large, rigorous trials to assess the utility of different interventions to improve use and titration of GDMT in HFrEF. Here, we review existing literature in GDMT implementation for HFrEF, and discuss future directions and considerations within the field.