Modern GDMT in HFrEF: Real World Case Insights

In this episode of CardioNerds Rounds, Dr. Karan Desai and Dr. Natalie Stokes are joined by Dr. Randall Starling (Cleveland Clinic), past Heart Failure Society of America president and transplant/MCS expert, to walk through the intricacies of implementing guideline-directed medical therapy (GDMT) in heart failure with reduced ejection fraction. They present a case of a man in his 60s with genetic cardiomyopathy (heart failure with reduced ejection fraction [HFrEF]~30%), atrial fibrillation, and rising filling pressures on right heart catheterization. The team discusses a physiology-driven transition to sacubitril/valsartan and eplerenone with nitroprusside support, illustrated by pre-‑ and post-right heart catheterization hemodynamics. They highlight key GDMT principles: cautious β‑blocker continuation, stepwise ARNI uptitration, protocol-based titration’s benefits, and the critical need to continue therapy—even post-recovery—to avoid relapse.

This podcast originally appeared on The CardioNerds.