What strategies should be used for initiating and titrating evidence-based therapies for patients with HFrEF?
Adjustment of therapies should occur every 2 weeks to achieve optimal GDMT within 3 to 6 months of an initial diagnosis of HF. GDMT should continue to be up-titrated to achieve maximally tolerated or targeted doses of these therapies. During follow-up, frequent reassessment of the clinical status of the patient, blood pressure, and kidney function (and electrolytes) should be performed. Structured medication titration plans embedded in disease management programs that articulate a strategy for drug initiation and strategies for follow-up have been shown to be useful in obtaining target doses of GDMT within 6 months of hospital discharge. Reassessment of ventricular function should occur 3 to 6 months after target (or maximally tolerated) doses of GDMT are achieved to determine the need for device therapies such as implantable cardioverter-debrillators and cardiac resynchronization therapy.