Heart failure (HF) remains a leading cause of morbidity and mortality, but timely initiation and optimization of guideline-directed medical therapy (GDMT) can meaningfully improve outcomes. In patients with HFrEF, comprehensive quadruple therapy—including a RAAS inhibitor, beta-blocker, mineralocorticoid receptor antagonist (MRA), and SGLT2 inhibitor—can reduce mortality by over 70%. Trials such as STRONG-HF have demonstrated that early, in-hospital or post-discharge uptitration lowers rehospitalization and death rates.

Comorbidities—particularly the cardiovascular–kidney–metabolic overlap—complicate management but highlight the need for individualized care. RAAS inhibitors reduce intraglomerular pressure and proteinuria. SGLT2 inhibitors decrease glucose reabsorption and myocardial stress, benefiting patients with or without diabetes. Nonsteroidal MRAs may also reduce renal decline and cardiovascular events in patients with type 2 diabetes and CKD. Therapy decisions must consider renal function, potassium levels, and blood pressure.

Risk stratification with tools such as LVEF, NT-proBNP, and NYHA class can guide therapy intensity and follow-up. For example, elevated NT-proBNP levels post-GDMT initiation are prognostic and can help refine monitoring strategies.

Multidisciplinary HF programs—including pharmacist-led titration, digital tools, and remote monitoring—can reduce readmissions by up to 40% and mortality by 25%.

How can your team best use pharmacist-led or digital titration to accelerate GDMT optimization in HFrEF? What strategies have been effective in overcoming therapeutic inertia and improving adherence?

Dr. Joanna Chikwui, Chief of Cardiac Surgery at Cedars-Sinai and Chair of AHA Scientific Sessions, spotlighted significant breakthroughs across cardiology. Updates included novel therapies for hyperlipidemia, gene-editing tools for inherited cardiovascular risk, innovations in atrial fibrillation management, and compelling lifestyle findings—including a surprising inverse relationship between moderate coffee intake and AF incidence.

Dr. Heidi May, Epidemiologist at Intermountain Health, presented results from the Target-D randomized trial, which found that personalized vitamin D dosing after myocardial infarction significantly reduced the risk of recurrent heart attack. These findings underscore the importance of individualized supplementation strategies and signal a broader shift toward precision prevention and risk stratification in cardiovascular care.

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