Classic pathobiologic and contemporary hierarchal classification schemes for heart failure (HF) establish the progressive nature of the clinical syndrome of HF. Failure to disrupt this cascade results in the well-described and still pressing burden of morbidity and mortality. Compelling research now informs effective interventions for HF stages A, B, C, and D.1 Yet these 4 partitions are very broad and may not reflect the different phenotypes of clinical disease to tailor management. The findings from the Global Approach to Lowering Adverse Cardiac Outcomes Through Improving Contractility in Heart Failure (GALACTIC-HF) randomized clinical trial were appropriately welcomed as a new treatment opportunity for patients with HF with reduced ejection fraction (HFrEF) and introduced a new drug class, myotrope, to the vernacular of HF therapeutics.2 However, because the overall clinical benefits among the patients enrolled in the GALACTIC-HF clinical trial were quite modest, a major question emerged: which patients may derive clinically relevant benefits?
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Yancy CW, Hernandez AF, Fonarow GC. Identifying Treatments for Stage C2 Heart Failure. JAMA Cardiol. Published online October 13, 2021. doi:10.1001/jamacardio.2021.4024
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