Doing Harm by Doing No Harm? Resisting the Urge to Retire GDMT in Older Adults With Heart Failure

The most recent projections suggest that the prevalence of heart failure with reduced ejection fraction (HFrEF) will dramatically expand as the United States’ population ages. 1 Tsao CW Aday AW Almarzooq ZI Anderson CAM Arora P Avery CL et al. Heart Disease and Stroke Statistics-2023 Update: a report from the American Heart Association. Circulation. 2023; Crossref Google Scholar Two decades have past since the benefit of the original pillars of guideline-directed medical therapy (GDMT), beta-blockers (BBs) and renin angiotensin system inhibitors (RASis) was first established in patients with HFrEF. Since then, the supportive data and armamentarium of therapies have only grown. 2 Dargie HJ. Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction: the CAPRICORN randomised trial. Lancet. 2001; 357: 1385-1390 Abstract Full Text Full Text PDF PubMed Scopus (1464) Google Scholar , 3 Packer M Fowler MB Roecker EB et al. Effect of carvedilol on the morbidity of patients with severe chronic heart failure: results of the carvedilol prospective randomized cumulative survival (COPERNICUS) study. Circulation. 2002; 106: 2194-2199 Crossref PubMed Scopus (1045) Google Scholar , 4 Fagerburg B and the MERIT-HF Study Group. Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF). Lancet. 1999; 353: 2001-2007 Abstract Full Text Full Text PDF Scopus (4434) Google Scholar , 5 Latini R Masson S Anand I et al. Effects of valsartan on circulating brain natriuretic peptide and norepinephrine in symptomatic chronic heart failure: the Valsartan Heart Failure Trial (Val-HeFT). Circulation. 2002; 106: 2454-2458 Crossref PubMed Scopus (280) Google Scholar , 6 Yusuf S Pitt B Davis CE Hood Jr, WB Cohn JN Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. N Engl J Med. 1992; 327: 685-691 Crossref PubMed Scopus (3508) Google Scholar