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Editorial
August 22/29, 2017

Biomarker-Guided vs Guideline-Directed Titration of Medical Therapy for Heart Failure

Author Affiliations
  • 1Division of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, California
JAMA. 2017;318(8):707-708. doi:10.1001/jama.2017.10540

Substantial progress has been made in the ability to reduce morbidity and mortality in patients with heart failure with reduced ejection fraction (HFrEF) with the advent of medical therapies, including angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists, angiotensin receptor neprilysin inhibitors, β-blockers, and mineralocorticoid receptor antagonists.1,2 In the pivotal randomized clinical trials, the dosing of medications has been guided by protocols to systematically uptitrate to achieve specific target doses or the highest tolerated dose.1,2 Accordingly, guidelines from the American College of Cardiology, American Heart Association, and Heart Failure Society of America recommend that these HFrEF guideline–directed medical therapies be uptitrated, as tolerated, to achieve target dosing.1,2

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