Assessment of Limitations to Optimization of Guideline-Directed Medical Therapy in Heart Failure From the GUIDE-IT Trial: A Secondary Analysis of a Randomized Clinical Trial

Study (n=838) found despite protocol-driven approach, many patients in GUIDE-IT did not receive medication adjustments and did not achieve optimal guideline-directed medical therapy, highlighting that opportunities exist to titrate medications for maximal benefit in heart failure

SPS commentary:

Medication adjustments were made during 2847 of 5218 qualified visits (54.6%). The most common reasons for not adjusting were “clinically stable” and “already at maximally tolerated therapy,” and at 6 months, only 130 patients (15.5%) achieved optimal guideline-directed medical therapy (≥50% of the target dose of β-blockers, ACE inhibitors or angiotensin receptor blockers, or any dose of mineralocorticoid antagonists).


JAMA Cardiology