Controversies and Trendy Topics in GDMT: 67 vs 41

In a spirited debate, discussants will examine the evidence supporting rapid initiation and uptitration of the four pillars of GDMT in new-onset heart failure. Is this the optimal strategy, given concerns around cost, tolerability, and the potential for reverse remodeling without full therapy? Speakers will debate the most effective approach to medical management in HFrEF.

The session will then review the role of inpatient GDMT initiation in patients admitted with and without acute decompensated heart failure, highlighting evidence-based strategies, timing, and practical considerations for safe implementation.

Finally, the discussion will address GDMT use in cardiogenic shock, including patients supported with temporary mechanical circulatory support (tMCS), exploring whether GDMT can facilitate recovery or remains of limited benefit in this setting.

Learning Objectives

• Summarize the evidence for rapid initiation and uptitration of GDMT in new-onset HFrEF.
• Apply practical strategies to initiate and titrate GDMT in complex inpatient settings.
• Discuss the role of GDMT in patients with cardiogenic shock and those supported with temporary MCS.