Related Experiment Video
Updated: Aug 16, 2026
09:20
Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
Personalizing Modern Heart Failure Therapy in HFrEF: Bridging Evidence, Clinical Practice, and Future Perspectives
Ehsan Shahverdi1, Amin Shahverdi2, Sendooran Shahi1
1Department of Cardiology, Rhythmology, Angiology and Intensive Care Medicine, Klinikum Osnabrück, Osnabrück, Germany.
Journal of the Saudi Heart Association
|August 15, 2026
Summary
Guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) is effective but underutilized. Optimizing implementation through phenotype-based strategies is key for better patient outcomes.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- Heart failure with reduced ejection fraction (HFrEF) significantly impacts morbidity and mortality globally.
- Despite advances, four foundational pharmacologic therapies (renin-angiotensin system inhibition/angiotensin receptor-neprilysin inhibition, beta-blockers, mineralocorticoid receptor antagonists, SGLT2 inhibitors) are underused in real-world settings.
Purpose of the Study:
- To review current evidence for guideline-directed medical therapy (GDMT) in HFrEF.
- To examine challenges in GDMT sequencing and optimization.
- To propose a phenotype-based framework for individualized treatment decisions.
Main Methods:
- A structured narrative review of literature from January 2000 to February 2026.
- Searches included PubMed/MEDLINE, Embase, and Google Scholar.
- Prioritized randomized controlled trials, guidelines, meta-analyses, and registries on GDMT initiation, sequencing, and implementation.
Main Results:
- Early, combined use of the four GDMT classes significantly reduces mortality and hospitalizations.
- Rapid initiation and uptitration are favored over sequential strategies.
- Barriers include hypotension, renal dysfunction, hyperkalemia, frailty, polypharmacy, and access issues.
Conclusions:
- The main challenge in HFrEF management is suboptimal delivery of proven therapies.
- Future progress relies on optimizing implementation via phenotype-informed, patient-centered strategies rather than new drug classes.
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