Table of ContentsView AllTable of ContentsGoal of TreatmentDrug TypesSide Effects and InteractionsManagement at HomeSpecialists to SeeHow to Support Heart Health
Table of ContentsView All
View All
Table of Contents
Goal of Treatment
Drug Types
Side Effects and Interactions
Management at Home
Specialists to See
How to Support Heart Health
Guideline-directed medical therapy (GDMT) for heart failure describes evidence-based therapies that professional cardiology associations recommend for managing heart failure with reduced ejection fraction (HFrEF). Specifically, these guidelines come from the American College of Cardiology, American Heart Association, and Heart Failure Society of America.
HFrEF is weakness of the heart muscle that leads to reduced contraction of the heart’s main pumping chamber, specifically anejection fraction(EF) less than 40% (compared to normal EF of greater than 50%).
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Goal of GDMT for Heart Failure
Heart failureis the weakness of the heart muscle that impairs blood flow to the body. It causes symptoms like shortness of breath, fatigue, and swelling that can interfere with daily activities.It also increases the risk of arrhythmias and sudden death. The goal of GDMT is to improve symptoms, prevent negative changes to the heart’s structure and lower the risk of complications like hospitalization for heart failure and death.
Four Drug Types and GDMT Order
The most recent recommendations from cardiology organizations have found found key medications for managing GDMT. It is recommended to start these medications within three months of a diagnosis of heart failure. These important medications include:
Adding Medications and Increasing DosageCardiologists may start with two or three of the medications at lower doses, and add the fourth and increase doses as tolerated. For example, someone with a new diagnosis of heart failure may start on a low dose of ARNI and beta-blocker, and within a few days or weeks, add a mineralocorticoid antagonist and SGLT2 inhibitor as their blood pressure allows. The goal is to take all four of the medications at the maximum tolerated doses that demonstrated benefit in the studies. A cardiologist or heart failure specialist can help manage the specific heart failure medications and doses.
Adding Medications and Increasing Dosage
Cardiologists may start with two or three of the medications at lower doses, and add the fourth and increase doses as tolerated. For example, someone with a new diagnosis of heart failure may start on a low dose of ARNI and beta-blocker, and within a few days or weeks, add a mineralocorticoid antagonist and SGLT2 inhibitor as their blood pressure allows. The goal is to take all four of the medications at the maximum tolerated doses that demonstrated benefit in the studies. A cardiologist or heart failure specialist can help manage the specific heart failure medications and doses.
Additional medications may be added based on individual characteristics. These may include:
Medication Side Effects and Interactions
All medications carry potential side effects and interactions with other medications.Additionally, depending on the cause and severity of heart failure, liver function, and kidney function, medications may be less well tolerated. Some medications are not recommended for use in pregnancy. Discuss all medications that you take, including over-the-counter medications and supplements, with your healthcare provider. Side effects of various heart failure medications are listed below.
Beta-Blockers
Beta-blockers counteract the effect of epinephrine (adrenaline). They can lower the heart rate and blood pressure and may cause the following symptoms:
ARNI
ARNI is a combination of an angiotensin receptor blocker and neprilysin inhibitor. It can lower blood pressure and cause the following symptoms:
ARNI should not be taken with ACE inhibitors or other ARBs, or with the direct renin inhibitor aliskiren.
Mineralocorticoid Receptor Antagonists
Mineralocorticoid antagonists are a type of diuretic and may cause the following:
SGLT2 Inhibitors
At-Home Management and Possible Hospitalization
Heart failure is a chronic (long-term) disease that may have periods of worsening symptoms, known asheart failure exacerbationor flares. These are serious and may require treatment in a hospital. There, intravenous medications can be given to help manage excess volume and electrolyte abnormalities.
At home, take your medications as prescribed and follow the recommendations of your healthcare team. They may ask you to limit the amount of salt in your diet and to limit your fluid intake. This is important to prevent fluid buildup, which leads to heart failure exacerbations.
It’s a good idea to keep track of the following and discuss any changes or concerns with your healthcare provider. It can help to keep a calendar or notebook to track the following:
Specialists Who Oversee GDMT Titration
Cardiologistsare heart specialists who diagnose and manage cardiovascular disease, including heart failure. Additionally, advanced heart failure practitioners are cardiologists who do extra training and focus on heart failure management. They also help manage people in need of heart pumps or a heart transplant.
Some people may not have access to a cardiologist if they live far away from a medical center.In such cases, primary care clinicians play a big role in managing heart failure.
What Is Titration?Titration is the adjustment of medications and their dosages. For heart failure, this means increasing or decreasing doses of fluid pills (diuretics) and other medications, based on symptoms and how well the person is tolerating therapy. Sometimes doses need to be lowered if there are side effects.
What Is Titration?
Titration is the adjustment of medications and their dosages. For heart failure, this means increasing or decreasing doses of fluid pills (diuretics) and other medications, based on symptoms and how well the person is tolerating therapy. Sometimes doses need to be lowered if there are side effects.
While on GDMT: Ways to Support Heart Health
In addition to taking medications to manage heart failure, a cardiologist may recommend the following to keep your heart healthy:
Summary
A cardiologist can tailor an individual approach that takes into account a person’s specific situation, and titrate the medication doses, and add additional recommended medications when indicated.
10 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Heart Association.Heart failure signs and symptoms.Maddox TM, Januzzi JL Jr, Allen LA, et al.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;83(15):1444-1488. doi:10.1016/j.jacc.2023.12.024MedlinePlus.Drug Reactions.Riemer TG, Villagomez Fuentes LE, Algharably EAE, et al.Do β-Blockers Cause Depression?: Systematic Review and Meta-Analysis of Psychiatric Adverse Events During β-Blocker Therapy.Hypertension. 2021;77(5):1539-1548. doi:10.1161/HYPERTENSIONAHA.120.16590Kallistratos MS, Pittaras A, Theodoulidis I, Grassos C, Poulimenos LE, Manolis AJ.Adverse Effects of Mineralocorticoid Receptor Antagonist Administration.Curr Pharm Des. 2018;24(46):5537-5541. doi:10.2174/1381612825666190222144359Pittampalli S, Upadyayula S, Mekala HM, Lippmann S.Risks vs Benefits for SGLT2 Inhibitor Medications.Fed Pract. 2018 Jul;35(7):45-48.Chrysohoou C, Mantzouranis E, Dimitroglou Y, Mavroudis A, Tsioufis K.Fluid and Salt Balance and the Role of Nutrition in Heart Failure.Nutrients. 2022 Mar 26;14(7):1386. doi:10.3390/nu14071386American Heart Association.Managing Heart Failure Symptoms.American College of Cardiology.No Practicing Cardiologist in Nearly Half of US Counties, Despite Higher CV, Mortality Risk.American Heart Association.Life’s Essential 8.
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Heart Association.Heart failure signs and symptoms.Maddox TM, Januzzi JL Jr, Allen LA, et al.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;83(15):1444-1488. doi:10.1016/j.jacc.2023.12.024MedlinePlus.Drug Reactions.Riemer TG, Villagomez Fuentes LE, Algharably EAE, et al.Do β-Blockers Cause Depression?: Systematic Review and Meta-Analysis of Psychiatric Adverse Events During β-Blocker Therapy.Hypertension. 2021;77(5):1539-1548. doi:10.1161/HYPERTENSIONAHA.120.16590Kallistratos MS, Pittaras A, Theodoulidis I, Grassos C, Poulimenos LE, Manolis AJ.Adverse Effects of Mineralocorticoid Receptor Antagonist Administration.Curr Pharm Des. 2018;24(46):5537-5541. doi:10.2174/1381612825666190222144359Pittampalli S, Upadyayula S, Mekala HM, Lippmann S.Risks vs Benefits for SGLT2 Inhibitor Medications.Fed Pract. 2018 Jul;35(7):45-48.Chrysohoou C, Mantzouranis E, Dimitroglou Y, Mavroudis A, Tsioufis K.Fluid and Salt Balance and the Role of Nutrition in Heart Failure.Nutrients. 2022 Mar 26;14(7):1386. doi:10.3390/nu14071386American Heart Association.Managing Heart Failure Symptoms.American College of Cardiology.No Practicing Cardiologist in Nearly Half of US Counties, Despite Higher CV, Mortality Risk.American Heart Association.Life’s Essential 8.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
American Heart Association.Heart failure signs and symptoms.Maddox TM, Januzzi JL Jr, Allen LA, et al.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;83(15):1444-1488. doi:10.1016/j.jacc.2023.12.024MedlinePlus.Drug Reactions.Riemer TG, Villagomez Fuentes LE, Algharably EAE, et al.Do β-Blockers Cause Depression?: Systematic Review and Meta-Analysis of Psychiatric Adverse Events During β-Blocker Therapy.Hypertension. 2021;77(5):1539-1548. doi:10.1161/HYPERTENSIONAHA.120.16590Kallistratos MS, Pittaras A, Theodoulidis I, Grassos C, Poulimenos LE, Manolis AJ.Adverse Effects of Mineralocorticoid Receptor Antagonist Administration.Curr Pharm Des. 2018;24(46):5537-5541. doi:10.2174/1381612825666190222144359Pittampalli S, Upadyayula S, Mekala HM, Lippmann S.Risks vs Benefits for SGLT2 Inhibitor Medications.Fed Pract. 2018 Jul;35(7):45-48.Chrysohoou C, Mantzouranis E, Dimitroglou Y, Mavroudis A, Tsioufis K.Fluid and Salt Balance and the Role of Nutrition in Heart Failure.Nutrients. 2022 Mar 26;14(7):1386. doi:10.3390/nu14071386American Heart Association.Managing Heart Failure Symptoms.American College of Cardiology.No Practicing Cardiologist in Nearly Half of US Counties, Despite Higher CV, Mortality Risk.American Heart Association.Life’s Essential 8.
American Heart Association.Heart failure signs and symptoms.
Maddox TM, Januzzi JL Jr, Allen LA, et al.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;83(15):1444-1488. doi:10.1016/j.jacc.2023.12.024
MedlinePlus.Drug Reactions.
Riemer TG, Villagomez Fuentes LE, Algharably EAE, et al.Do β-Blockers Cause Depression?: Systematic Review and Meta-Analysis of Psychiatric Adverse Events During β-Blocker Therapy.Hypertension. 2021;77(5):1539-1548. doi:10.1161/HYPERTENSIONAHA.120.16590
Kallistratos MS, Pittaras A, Theodoulidis I, Grassos C, Poulimenos LE, Manolis AJ.Adverse Effects of Mineralocorticoid Receptor Antagonist Administration.Curr Pharm Des. 2018;24(46):5537-5541. doi:10.2174/1381612825666190222144359
Pittampalli S, Upadyayula S, Mekala HM, Lippmann S.Risks vs Benefits for SGLT2 Inhibitor Medications.Fed Pract. 2018 Jul;35(7):45-48.
Chrysohoou C, Mantzouranis E, Dimitroglou Y, Mavroudis A, Tsioufis K.Fluid and Salt Balance and the Role of Nutrition in Heart Failure.Nutrients. 2022 Mar 26;14(7):1386. doi:10.3390/nu14071386
American Heart Association.Managing Heart Failure Symptoms.
American College of Cardiology.No Practicing Cardiologist in Nearly Half of US Counties, Despite Higher CV, Mortality Risk.
American Heart Association.Life’s Essential 8.
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