Dr Stephen J Greene (Duke University School of Medicine, Durham, NC, US) joins us to discuss the practical realities of delivering guideline-directed medical therapy (GDMT) in heart failure, and how clinicians and programmes can move more patients towards near-optimal treatment despite the constraints of everyday practice.

In this interview, Dr Greene addresses the persistent gap between what trials and guidelines recommend and what front-line clinics are able to deliver. He considers how hard to push rapid, quadruple GDMT in the face of common real-world obstacles and offers a practical, programme-level change designed to get substantially more patients to near-optimal therapy over the coming year. He also reflects on whether current GDMT targets are realistic for front-line settings, or whether the field can ask more of systems and patients than they can reasonably deliver.

Interview Questions:

1. How hard do you push rapid, quadruple GDMT when you are facing hypotension, kidney concerns, adherence issues, and limited clinic capacity?
2. For a typical HF programme today, what is the one practical change you would recommend to get many more patients to near-optimal GDMT over the next year?
3. Do you think current GDMT targets are realistic for front-line clinics, or are we sometimes asking more than systems can deliver?

Editors: Jordan Rance
Videographer: Oliver Miles, David Ben-Harosh
Support: This is an independent interview produced by Radcliffe Cardiology.