What is a cost-effective GDMT strategy for HFmrEF/HFpEF?

We built a model w/ clinical trial data (TOPCAT, PARAGON-HF, EMPEROR/DELIVER) and simulated outcomes w/ regimens of MRA/SGLT2i/ARNi.

Best 💊 combo?
MRA + SGLT2i

ARNi ⬇️ value at current 💵

Treat HF with urgency!

Digoxin —an underutilized drug? Once widely used for heart failure, digoxin has fallen to the wayside in deference to quad therapy proven mortality benefit. However, hospitalization reduction render it possible add-on therapy for symptoms despite max GDMT. DIG Trial, NEJM 1997 ♥️

A friendly reminder that the often deferred MRA demonstrated the greatest absolute reduction in all-cause mortality of all GDMT drugs and devices in its respective landmark HFrEF trial

#HeartFailure2024 Sex Disparities of GDMT in HF ⁦Marco Metra⁩ ⁦HoT-TR⁩

Effects of #GDMT across Kidney Function Spectrum

✅ #BB : consistent benefit to eGFR 30
✅ #ARNI : consistent benefit to eGFR 30
✅ #SGLT2i : consistent benefit to eGFR 20
❌ #SteroidalMRA : ↓ benefit & worse safety at lower eGFR

New strategies to block MR axis in HF & CKD needed!

🫀There is life beyond GDMT in #heartfailure

👉Our latest review on combined #diuretic treatment in #heartfailure is available: link.springer.com/article/10.100…

💡We review the recent research and offer a practical approach to manage congestion with a focus on combinational therapy

Did you know the lack of GDMT practice can increase the risk of rehospitalization for heart failure patients?

Learn more about a treatment option that is a component of the AHA/ACC/HFSA Guidelines for treating #HeartFailure : bit.ly/inpefahcp

#Sotagliflozin

Excellent #LBCT presentation by Laura Cohen on cardiac reverse remodeling following an accelerated GDMT uptitration program #TEAMHF !

🔑 findings 👇

Love the take from this review article on decongestion in acute heart failure.

Need to avoid de-escalating GDMT in acute HF to “make room” for decongestion. Loops exacerbate maladaptive neurohormonal abnormalities.

⬆️ GDMT
➕ loop diuretic

sciencedirect.com/science/articl…

Impressive results from REVOLUTION HF presented by Lisa Anderson in#HeartFailure2024. When ntprobnp is suggesting hf, some diuretics is used but gdmt stays more or less the same. ⁦Gregg Fonarow MD⁩

📌Manejo contemporáneo de la #InsuficienciaCardiaca guía Americana & Europea

🔜Camino a la definición universal
🙌🏻 Rápida introducción y optimización de GDMT integral
🚨 Las diferencias existen y están relacionadas al tiempo de aparición de la evidencia en relación a su

Always sad to see a young heart in trouble.

Did you know that < 7% of patients with #HF REF receive optimal #GDMT a full year after this life threatening diagnosis?

#CRT is underutilized also.

What #barriers do you experience in clinical settings?

#HF #LVThrombus #EchoFirst

Reminder: GDMT titration is about maximally tolerated doses for the patient ✨ in front of us ✨, not target doses!

医局の製品説明会でアニキが☝️
Simple GDMTスコア、当院も使い始めました♪
Ryuichi Matsukawa @カテと心不全

In a cluster RCT, HFrEF patients allocated to GDMT implementation led by a pharmacist were >2-fold more likely to intensify beta-blocker and/or RAASi therapy. A meta-analysis reported that pharmacist-led interventions in outpatient HF care could improve adherence to GDMT and QoL.

📌Enhanced Decongestive Therapy ?
Consider carefully, not for all pts with AHF
🟠minimal improvement in symptoms or outcomes
🔴risk of significant side effects
🟢instead, focus on early initiation of GDMT
doi.org/10.1016/j.jacc…
#AHF #heartfailure #HeartFailure

Great paper on decongestion of acute #heartfailure alongside uptitration of #GDMT .. the way I see it.. YOU NEED BOTH !

Before Epic, CareEverywhere, 20-patient templates, 10 drugs as GDMT for each patient 🤣, shared-decision making, MyChart direct patient messages, HealthStream compliance training on 🔥 safety, and during the days when you could read this article in print, not on your 📱

Rapid & intensive GDMT in🫀failure

Heart failure 👉🏼 common, costly & associated with poor outcomes 🏥

Combined GDMT 👉🏼 provides clear, incremental, additive ⤵️ in ☠️ and

📣 74% RRR in ☠️ & 🏥 ‼️

Early combined initiation saves lives 👉🏼 STRONG-HF

🔑 every appointment is

🚨New in JACC Journals w #ACC24

🇺🇸 analysis of newly diagnosed #HFrEF

>4 in 5 pts eligible for quad GDMT

Yet, <1 in 6 prescribed it.

Potentially completely generic triple GDMT (RASi + BB + MRA)??.....only ~4 in 10 eligible pts even prescribed this.

jacc.org/doi/10.1016/j.…