Optimising Heart Failure Therapy in 2026: How to Make GDMT Happen in the Real World

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: How hard do you push rapid, quadruple GDMT when you are facing hypotension, kidney concerns, adherence issues, and limited clinic capacity? 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? 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: Tom Green, David Ben-Harosh Support: This is an independent interview produced by Radcliffe Cardiology. Visit Radcliffe Cardiology: https://www.radcliffecardiology.com/ This content is intended for healthcare professionals only. Radcliffe brings medical knowledge, insight and innovation to life for CV clinicians around the world, using our communications & creative expertise, our platforms and connections across the community to help transform theory into practice faster. Like us on Facebook:   / radcliffecardiology   Follow us on X: https://x.com/radcliffeCARDIO