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. Author manuscript; available in PMC: 2018 Nov 1.
Published in final edited form as: Circ Heart Fail. 2017 Nov;10(11):e004478. doi: 10.1161/CIRCHEARTFAILURE.117.004478

Figure 2. How Long Does It Take to Optimize Guideline-Directed Medical Therapy in Newly-Diagnosed Heart Failure with Reduced Ejection Fraction?

Figure 2

We have developed a theoretical timeline for the step-wise initiation and uptitration of 3–4 drugs in contemporary regimens for newly-diagnosed heart failure with reduced ejection fraction. Starting doses, target doses, titration schedule, and necessary laboratory monitoring were based on suggestions from the 2016 European Society of Cardiology Guidelines.9 This generic timeline does not account for pre-existing therapies, specific order of initiation of therapies, or simultaneous drug uptitration. Abbreviations: ACEi = angiotensin-converting enzyme inhibitor; ARB = angiotensin II receptor blocker; ARNi = angiotensin receptor neprilysin inhibitor; EF = ejection fraction; GDMT = guideline-directed medical therapy; MRA = mineralocorticoid receptor antagonist.