Filling the gaps in guideline-directed care

As American clinicians have tried to reduce heart failure rehospitalizations and improve care for patients with heart failure with reduced ejection fraction (HFrEF), the population of patients who have heart failure with preserved ejection fraction (HFpEF) has emerged as needing attention. Although HFrEF and HFpEF share some characteristics, treatment approaches are different, and treatment options for HFpEF are more limited. All patients would benefit from guideline-directed medical treatment. The FDA has expanded the indications for sacubitril/valsartan to encompass both patients with HFrEF and selected patients with HFpEF, and the sodium-glucose cotransporter-2 inhibitors to reduce heart failure hospitalizations and the risk of cardiovascular death in symptomatic patients with HFrEF. It has also approved vericiguat, an oral soluble guanylyl cyclase activator. In addition, investigators are examining possible uses of omecamtiv mecarbil and nonsteroidal aldosterone antagonists in heart failure. Addressing heart failure is a team effort, and such teams need overlapping expertise, innovative approaches, and resources that support and sustain their efforts. Team members should familiarize themselves with the American College of Cardiology 2021 Update to the 2017 Expert Consensus Decision Pathway as a means to offer the best care to the patients that they serve.