Abstract：
Despite robust scientific evidence and strong guideline recommendations, there remain significant gaps in initiation and dose titration of guideline-directed medical therapy (GDMT) for heart failure (HF) among eligible patients. Reasons surrounding these gaps are multifactorial, and largely attributed to patient, healthcare professionals, and institutional challenges. Concurrently, HF remains a predominant cause of mortality and hospitalization, emphasizing the critical need for improved delivery of therapy to patients in routine clinical practice. To optimize GDMT, various implementation strategies have emerged in the recent decade such as in-hospital rapid initiation of GDMT, improving patient adherence, addressing clinical inertia, improving affordability, engagement in quality improvement registries, multidisciplinary clinics, and EHR-integrated interventions. This review highlights the current use and barriers to optimal utilization of GDMT, and proposes novel strategies aimed at improving GDMT in HF.
摘要：
尽管有强有力的科学证据和强有力的指南建议，在符合条件的心力衰竭(HF)患者中,指南指导的药物治疗(GDMT)的起始和剂量滴定仍存在显著差距.围绕这些差距的原因是多方面的，主要归因于病人，医疗保健专业人员,和体制挑战。同时,HF仍然是死亡和住院的主要原因，强调在常规临床实践中改善患者治疗的迫切需要。为了优化GDMT，在最近十年中出现了各种实施策略，例如在医院内快速启动GDMT，提高患者依从性，解决临床惯性，提高承受能力，参与质量改进登记处，多学科诊所,和EHR综合干预措施。这篇综述强调了GDMT的当前使用和最佳利用的障碍，并提出了旨在改善HF中GDMT的新策略。
