Guideline-Directed Medical Therapy in Heart Failure: The Need for Speed

Heart failure (HF) represents one of the most pressing health challenges globally, affecting more than 64 million people worldwide.Despite therapeutic progress, HF remains a leading cause of hospitalization and mortality, particularly in patients with reduced ejection fraction (HFrEF), with annual costs, including hospitalizations, pharmacotherapy, and productivity losses, measured in the hundreds of billions of dollars [1,2]. Readmissions remain common: roughly one in four patients is rehospitalized within 30 days in many healthcare systems, and one in two within 6 months, reflecting not only the complexity of patients with HF but also the challenges of post-discharge care [3].Despite decades of advances, 5-year mortality in HF approximates that of many cancers, thereby underscoring the urgency for better care delivery [2,3].Currently, multiple therapies unequivocally reduce death and hospitalization in HFrEF.Yet, these therapies are initiated late, under-titrated, or discontinued in routine practice, hence diluting the benefits seen in trials [4,5].Guideline-directed medical therapy (GDMT) refers to the evidencebased "four pillars" that form the pharmacologic backbone of HFrEF care: angiotensin receptorneprilysin inhibitor (ARNI) or, where unavailable, angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB); evidencebased beta-blockers; mineralocorticoid receptor