TAVR and HFrEF — Are We Fully Applying GDMT? | JACC Baran

Hosts Mitsuaki Sawano, MD, and colleagues welcome Dr. Yusuke Kobari, MD, PhD (Heart Center, Copenhagen) to discuss his recent publication in JACC: Cardiovascular Interventions, “Clinical Application of Guideline-Directed Medical Therapy in TAVR Patients With Heart Failure and Reduced Ejection Fraction.” Among 336 patients with LVEF ≤40%, most were eligible for quadruple HF therapy, yet only 27% received it by 3 months. Patients on more complete GDMT had lower 2-year rates of cardiovascular death or heart failure hospitalization, while those on fewer agents had higher event rates. This episode explores an essential message: TAVR is not the endpoint of care in patients with HFrEF. Even in the structural heart era, optimization of foundational HF pharmacotherapy remains a central consideration—raising important questions about how we integrate procedural success with longitudinal medical management.