ACC Expert Consensus statement 2024 for Treatment of HFrEF: Key Points

2024 ACC Expert Consensus Decision Pathway for Treatment of Heart Failure With Reduced Ejection Fraction: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol 2024;Mar 8:[Epub ahead of print].       In line with recent evidence and guidelines, the recommended core guideline-directed medical therapy (GDMT) for chronic heart failure (HF) includes an angiotensin II receptor/neprilysin inhibitor (ARNI), evidence-based beta-blocker, sodium-glucose cotransporter (SGLT) inhibitor, and mineralocorticoid antagonist (MRA). When feasible, early and rapid initiation of these therapies and titration to maximally tolerated doses within 3 months is recommended. While no specific order of initiation or titration of guideline-directed medical therapy is mandated, the following is some useful guidance a)Start with low doses of core therapies. b) Delay beta-blocker initiation until HF is compensated. c) ARNIs and SGLT inhibitors may reduce diuretic needs. d) MRA and SGLT inhibitors may have minimal BP effects. e) Mild declines in eGFR don't always require medication cessation.  Difficulties with adherence to recommended HF therapies can be multifactorial. Effective strategies to improve adherence should be targeted to individual patient needs. Strategies include patient education, simplification of overall medication regimen, reduction of cost and access barriers, medication reminders, utilization of clinical pharmacist, and cognitive behavioral therapies. In addition to managing cardiovascular (CV) comorbidities, attention should be paid to addressing non-CV comorbidities that impact HF outcomes such as diabetes, chronic kidney disease, sleep-disordered breathing, iron deficiency, and viral infections (prevention with vaccination).   Disclaimer: Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.