I have always been fascinated by the advances in heart failure specially with the mechanical circulatory support (MSC) devices. Cardiogenic shock is no longer simply cardiogenic shock but a syndrome with a wide array of different presentations as demonstrated by the SCAI Expert Consensus on the Classifications of Cardiogenic Shock (Figure 1) or better yet as one my colleagues, Dr. Anshul Srivastava calls it “The stages of cardiology fellow anxiety”
I got the chance to be part of the AHA’s Scientific Sessions 2019 for the first time as an AHA Early Career Blogger. The first session that I attended was titled “Mechanical Hemodynamic Support for Cardiogenic Shock in the Modern Era’’
It was a good one with the experts sharing the latest on the topic and future directions. MCS devices are exciting and at times, in a close to ideal scenario, a good “last minute” resort for our advance heart failure patients either as destination therapy, and/or bridge to transplant or to recovery. However, I came to the realization that we must not forget about GDMT (guideline directed medical therapy). GDMT for chronic heart failure with reduced ejection(HFrEF) works.
They are class I and II ACC/AHA guideline recommendations for a reason. As a new early career blogger for AHA, I wanted to take the opportunity to stress how the importance of GDMT and furthermore our role in assuring that our patients with cardiomyopathy are on the correct medications at the appropriate dosages. All of us, active on social media let’s make the hashtag “GDMTworks” trend. Let’s always remember, it works. Let us constantly remind ourselves and our colleagues that this is supported by evidence.
After starting and optimizing the medications. We must be persistent. We must not give up. We must push. It does work. And if it’s not working, we must make sure that our patients are on the optimal medications and dosages before charting “Failed Medical Therapy’’. Having said that, I will quote Dr. Everett Koop1, “Drugs don’t work in patients who don’t take them’’.
Our options for medical therapy continue to grow. With DAPA-HF, we are possibly witnessing the recruitment of another medication joining the “GDMT” crew. The possibilities are endless and it might just be the beginning for GDMT with “Quadruple therapy in heart failure2 “
I chose to talk about this topic because it is in my opinion that at times we are at fault for not been aggressive with GDMT in the treatment of chronic HFrEF. We often throw in the towel early in the game forgetting that we have another quarter to play. You got this. It’s not over yet. Start the medications. Optimize the medications, educate your patient on how effective GDMT can be. If you don’t believe it works, how will you ever convince your patient otherwise. Most importantly, spread the word and share your stories with the hashtag #GDMTworks .
In conclusion, to highlight Dr. Robert Harrington take away message from the presidential session “Evidence matters”. Let’s make it count and reinforce the evidence for the sake of our patients.
1. Cramer JA. Enhancing patient compliance in the elderly. Role of packaging aids and monitoring. Drugs Aging. 1998; 12:7–15.
2. G. Michael Felker. Building the Foundation for a New Era of Quadruple Therapy in Heart Failure. Circulation. Nov 2019.
The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.
Michel Ibrahim is a physician cardiologist in training living the dream at the Boston University and Boston Medical Center. His clinical interests include cardiomyopathies, advanced heart failure, cardiogenic shock and hemodynamics. He has a specialist interest in global cardiovascular health. He is currently working on starting a non-profit organization to provide research, educational opportunities and tailored health care specific the island of Haiti. ON Twitter, follow @DrMichelIbrahim