Key Steps to Optimizing GDMT in Heart Failure

This transcript has been edited for clarity.

Hello. My name is Biykem Bozkurt. I'm a heart failure cardiologist, professor of medicine, senior dean of faculty, and director of Winters Center for Heart Failure Research at Baylor College of Medicine. Today, we're discussing tips for optimizing guideline-directed medical therapy (GDMT) in heart failure.

I want to talk about optimization strategies according to stages of heart failure in clear steps according to ejection fraction classification. In the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure, we have specific recommendations according to stages of heart failure. We revised the heart failure stage terminologies for these to be better understood by our patients and by nonspecialists.

The first stage in heart failure is patients with risk factors, such as diabetes, hypertension, coronary artery disease, and obesity, but without symptoms or signs or functional or structural cardiac abnormalities. We define this as stage A or at risk for heart failure.

The second stage is patients without symptoms or signs but with structural, functional, or biomarker abnormalities. This stage is called pre–heart failure or stage B. Patients with current or prior symptoms of heart failure are called stage C or symptomatic heart failure. Patients with advanced symptoms or signs with high-risk features, such as repeated hospitalizations or intolerance to GDMT, is defined as advanced heart failure or stage D.