Navigating between Scylla and Charybdis: challenges and strategies for implementing guideline-directed medical therapy in heart failure with reduced ejection fraction

Seferović P.M. Polovina M. Adlbrecht C. Bělohlávek J. Chioncel O. Goncalvesová E. Milinković I. Grupper A. Halmosi R. Kamzola G. Koskinas K.C. Lopatin Y. Parkhomenko A. Põder P. Ristić A.D. Šakalytė G. Trbušić M. Tundybayeva M. Vrtovec B. Yotov Y.T. Miličić D. Ponikowski P. Metra M. Rosano G. Coats A.J.S.
December 2021 John Wiley and Sons Ltd

European Journal of Heart Failure
2021 #23 Issue 12 1999 - 2007 pp.

Guideline-directed medical therapy (GDMT) has the potential to reduce the risks of mortality and hospitalisation in patients with heart failure (HF) with reduced ejection fraction (HFrEF). However, real-world data indicate that many patients with HFrEF do not receive optimised GDMT, which involves several different medications, many of which require up-titration to target doses. There are many challenges to implementing GDMT, the most important being patient-related factors (comorbidities, advanced age, frailty, cognitive impairment, poor adherence, low socioeconomic status), treatment-related factors (intolerance, side-effects) and healthcare-related factors that influence availability and accessibility of HF care. Accordingly, international disparities in resources for HF management and limited public reimbursement of GDMT, coupled with clinical inertia for treatment intensification combine to hinder efforts to provide GDMT. In this review paper, authors aim to provide solutions based on available evidence, practical experience, and expert consensus on how to utilise evolving strategies, novel medications, and patient profiling to allow the more comprehensive uptake of GDMT. Authors discuss professional education, motivation, and training, as well as patient empowerment for self-care as important tools to overcome clinical inertia and boost GDMT implementation. We provide evidence on how multidisciplinary care and institutional accreditation can be successfully used to increase prescription rates and adherence to GDMT. We consider the role of modern technologies in advancing professional and patient education and facilitating patient–provider communication. Finally, authors emphasise the role of novel drugs (especially sodium–glucose co-transporter 2 inhibitors), and a tailored approach to drug management as evolving strategies for the more successful implementation of GDMT.

Guideline-directed medical therapy , Health education , Heart failure , Medication adherence , Optimal treatment , Quality of care , Sodium–glucose co-transporter 2 inhibitors

Text of the article Перейти на текст статьи

Faculty of Medicine, Belgrade University, Belgrade, Serbia
Serbian Academy of Sciences and Arts, Belgrade, Serbia
Department of Cardiology, University Clinical Centre, Belgrade, Serbia
Imed19-privat, Private Clinical Research Center, Vienna, Austria
Second Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
University of Medicine Carol Davila, Bucharest, Romania
Emergency Institute for Cardiovascular Diseases “Prof. C.C. Iliescu”, Bucharest, Romania
Department of Cardiology, Faculty of Medicine Comenius University and National Cardiovascular Institute, Bratislava, Slovakia
Cardiology Division, Sheba Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
First Department of Medicine, University of Pecs, Medical School, Pecs, Hungary
Kamzola: Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia
Department of Cardiology, Bern University Hospital, Bern, Switzerland
Regional Cardiology Centre Volgograd, Volgograd State Medical University, Volgograd, Russian Federation
Emergency Cardiology Department, Institute of Cardiology, Kyiv, Ukraine
First Cardiology Department, North Estonia Medical Centre Foundation, Tallinn, Estonia
Department of Cardiology, Medical Academy, Faculty of Medicine Lithuanian University of Health Sciences, Kaunas, Lithuania
School of Medicine, University of Zagreb, Zagreb, Croatia
Department of Cardiology, Kazakh National Medical University, Almaty, Kazakhstan
Department of Cardiology, UMC, Ljubljana, Slovenia
First Department of Internal Medicine, Medical University of Varna, Varna, Bulgaria
Second Cardiology Clinic, University Hospital St. Marina, Varna, Bulgaria
Centre for Heart Diseases, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
Cardiology, ASST Spedali Civili; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
RCCS San Raffaele Pisana, Rome, Italy
University of Warwick, Coventry, United Kingdom

Faculty of Medicine
Serbian Academy of Sciences and Arts
Department of Cardiology
Imed19-privat
Second Department of Medicine - Department of Cardiovascular Medicine
University of Medicine Carol Davila
Emergency Institute for Cardiovascular Diseases “Prof. C.C. Iliescu”
Department of Cardiology
Cardiology Division
First Department of Medicine
Kamzola: Latvian Centre of Cardiology
Department of Cardiology
Regional Cardiology Centre Volgograd
Emergency Cardiology Department
First Cardiology Department
Department of Cardiology
School of Medicine
Department of Cardiology
Department of Cardiology
First Department of Internal Medicine
Second Cardiology Clinic
Centre for Heart Diseases
Cardiology
RCCS San Raffaele Pisana
University of Warwick

10 лет помогаем публиковать статьи Международный издатель

Книга Публикация научной статьи Волощук 2026 Book Publication of a scientific article 2026