Implementing Guideline-Directed Medical Therapy for Heart Failure: JACC Focus Seminar 1/3.

Despite the availability of lifesaving guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF), there remain major gaps in utilization of these therapies among eligible patients. Simultaneous with these gaps in quality of care, HFrEF continues as a leading cause of death and hospitalization with associated clinical risk far exceeding most other cardiovascular and noncardiovascular conditions. In the context of this urgent need to improve provision of appropriate therapy, multiple lines of evidence support various implementation strategies. Such strategies include in-hospital initiation of GDMT, simultaneous or rapid sequence initiation of GDMT, participation in quality improvement registries to assess site performance and provide feedback, multidisciplinary titration clinics, virtual consult teams, reduction of cost-sharing, remote algorithm-based medication optimization, electronic health record-based interventions, and direct-to-patient educational initiatives. This review describes and contextualizes the evidence surrounding each of these potential avenues for improving use of foundational GDMTs for patients with HFrEF. [Display omitted] • There are wide gaps in use of guideline-recommended medications for patients with HFrEF. • Several strategies are available to improve utilization of GDMT for HFrEF. • Wider adoption of these strategies could enhance quality of care and clinical outcomes for a large number of patients. [ABSTRACT FROM AUTHOR]