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Doctors prescribe a combination of drugs to treat people’s different symptoms. Heart failure is a progressive disease for which there is no cure. However, people who take their medications and make healthy lifestyle choices can maintain a high quality of life. The American Heart Association (AHA) explains that heart failure is when the heart cannot pump enough blood around a person’s body to keep their organs and cells supplied with oxygen and nutrients. It usually affects the left side of a person’s heart first. Doctors can measure the amount of blood a person’s left ventricle pumps out with each heartbeat. They express this as a percentage called the ejection fraction. According to the Heart Failure Society of America (HFSA), a healthy heartbeat pumps about 60% of blood from the ventricle. However, if this percentage drops below, or is equal to, 40%, doctors will diagnose a person with heart failure with a reduced ejection fraction (HFrEF). Guideline-directed medical therapy (GDMT) helps doctors treat people with HFrEF. This article explains what GDMT for heart failure is, and the types of medications used. What is GDMT Share on PinterestVincent Starr Photography/Getty ImagesAccording to an article published in the AHA’s journal, Circulation, GDMT is part of the clinical practice guidelines for doctors treating people with HFrEF. Clinical practice guidelines help doctors standardize treatments for medical conditions, ensuring that everyone has access to the best possible treatment for their condition. GDMT for people with HFrEF includes the use of four different heart medications. It also includes recommendations for implantable cardioverter defibrillators (ICDs). When a person has heart failure, their heart beats faster than usual, which can cause an irregular heart rhythm. An ICD monitors a person’s heartbeats and delivers an electric shock if their rhythm is dangerously fast. The shock restores a normal heartbeat. Who needs GDMT Everyone with HFrEF benefits from GDMT, as it allows access to standardized care across the United States and Europe. A 2021 study published in the journal Clinical Cardiology found that the absence of GDMT increased the risk of a person dying from HFrEF by 29%. The guidelines also help doctors keep up to date with medical advances and changes in drug prescription protocols. Will a person need a hospital stay Doctors can prescribe some GDMT medications without admitting a person to a hospital. The clinical practice guidelines recommend using medication before a person has surgery to fit an ICD. If doctors recommend surgery, the person will need a hospital stay. Medical advances mean that many people using GDMTs can manage their symptoms without an ICD. A 2022 study says more research is necessary to determine whether drugs alone can improve a person’s outlook. Medications GDMT for HFrEF includes four different classes of medication. These include beta-blockers, angiotensin receptor neprilysin inhibitors, mineralocorticoid receptor antagonists, and sodium glucose cotransporter-2 inhibitors. Beta-blockers Beta-blockers work by slowing a person’s heart rate and reducing the force with which their heart pumps. This can help lower a person’s blood pressure. A 2021 study published in the Journal of Cardiovascular Development and Disease identifies beta-blockers suitable for HFrEF. These are:bisoprolol (Zebeta)carvedilol (Coreg)metoprolol (Toprol)nebivolol (Bystolic) The U.S. guidelines do not include nebivolol, but the European guidelines do include it. Angiotensin receptor neprilysin inhibitors Sacubitril/valsartan is the first angiotensin receptor neprilysin inhibitor (ARNI) to gain approval from the Food and Drug Administration (FDA), and doctors can prescribe it for people with HFrEF. Entresto is its common brand name. The active components of sacubitril/valsartan work in different ways. Sacubitril reduces the levels of sodium and water in a person’s urine, while valsartan blocks a hormone called angiotensin II. Together, these drugs reduce strain on the heart. Mineralocorticoid receptor antagonists Mineralocorticoid receptor antagonists (MRAs) are also known as aldosterone antagonists. Doctors often prescribe spironolactone (Aldactone) or eplerenone (Inspra). These drugs are diuretics or water pills. Sodium glucose cotransporter-2 inhibitors Doctors usually prescribe sodium glucose cotransporter-2 (SGLT-2) inhibitors to help people with type 2 diabetes regulate their glucose levels, but studies show it can also help people with HFrEF. The AHA reports that one SGLT-2 inhibitor, dapagliflozin reduces a person’s risk of death and prevented their heart failure from getting worse. What can I do to manage my heart failure at home The AHA recommends lifestyle changes to help people manage their heart failure at home, including:eating a heart-healthy diet with plenty of fruit and vegetables, whole grains, low fat dairy products, and lean proteinsbeing more physically active by exercising dailymaintaining a moderate weightquitting or limiting smokingavoiding or limiting alcoholavoiding or limiting caffeinelooking out for sudden weight changes — notify a doctor if you experience a change of more than 3 pounds (lb) in a day or 5 lb in a week Other treatments Taking medicines as prescribed can help a person manage their symptoms of heart failure. Cutting back on fluids and reducing a person’s sodium intake may also help. Some people with heart failure may need ICDs or even a heart transplant. When to contact a doctor According to a 2022 review published in The American Journal of Managed Care, some people experience adverse side effects from GDMT medications. These include dizziness, a slow heart rate, abnormally low blood pressure, and kidney damage. People with these symptoms should talk with a doctor immediately. HFrEF is a progressive disease, so people need to monitor their symptoms and report any changes to a healthcare professional immediately. According to the AHA, changes include:rapid weight gain, especially if more than 3 lb in one dayswelling in the legs and ankles or abdomenshortness of breath, particularly when restingfatiguea loss of appetitea dry cough Outlook While there is no cure for heart failure, medication and lifestyle changes can delay its progression. Studies show that GDMT can treat a person’s symptoms effectively. Studies also show that people who do not control their symptoms using GDMT have a 29% higher risk of mortality over a 2-year period. Summary GDMT stands for guideline-directed medical therapy, which is clinical practice guidelines. GDMT for heart failure is a drug-based therapy using a combination of up to four heart medications. Studies show that GDMT for heart failure is effective and provides a foundation for doctors to treat people with HFrEF. Last medically reviewed on September 28, 2022Heart DiseaseDrugsheartvalvedisorders 11 sourcescollapsedMedical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. We avoid using tertiary references. We link primary sources — including studies, scientific references, and statistics — within each article and also list them in the resources section at the bottom of our articles. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.Butzner, M., et al. (2022). Adverse drug effects across patients with heart failure: A systematic review.https://www.ajmc.com/view/adverse-drug-effects-across-patients-with-heart-failure-a-systematic-reviewCarnicelli, A. P., et al. (2021). Sodium-glucose cotransporter-2 inhibitors in patients with heart failure with reduced ejection fraction. https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.052048Dhande, M., et al. (2022). GDMT and risk of death with primary prevention ICDs [Abstract].https://www.acc.org/Latest-in-Cardiology/Journal-Scans/2022/08/03/17/21/Guideline-Directed-Medical-TherapyHealth topics. (n.d.).https://www.heart.org/en/health-topicsHeart failure [Fact sheet]. (2020).https://www.cdc.gov/heartdisease/heart_failure.htmHeart failure facts & information. (n.d.).http://hfsa.org/patient-hub/heart-failure-facts-informationKosiborod, M. N., et al. (2020). Effects of dapagliflozin on symptoms, function, and quality of life in patients with heart failure and reduced ejection fraction.https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.119.044138Masarone, D., et al. (2021). The use of β-blockers in heart failure with reduced ejection fraction.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8468030/McCullough, P. A., et al. (2021). Mortality and guideline-directed medical therapy in real-world heart failure patients with reduced ejection fraction.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8427999/Morris, A. A., et al. (2022). Updated heart failure guidelines: Time for a refresh.https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.059104Nicolas, D., et al. (2022). Sacubitril/valsartan.https://www.ncbi.nlm.nih.gov/books/NBK507904/FEEDBACK:Medically reviewed by Alan Carter, Pharm.D. — By Belinda Weber on September 28, 2022 Latest newsWhat sets 'SuperAgers' apart? 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