Four-class medicine regimen in heart failure (guideline-directed medical therapy)
The four classes of medicine that an ACC summary of the 2022 heart failure guideline from the AHA, ACC and HFSA calls guideline-directed medical therapy: renin-angiotensin system inhibition (an ARNI, ACE inhibitor or angiotensin receptor blocker), beta blockers, mineralocorticoid receptor antagonists and SGLT2 inhibitors. The summary says everyone with heart failure now or in the past, whatever their ejection fraction, should be considered for this therapy. It says an ARNI is now the first choice within the first class when the ejection fraction is reduced.
Also called Guideline-directed medical therapy · GDMT
- Intervention
- In this atlas
Overview
Technical summary
Regimen record. The source is the ACC key-perspectives summary of the guideline (hash only, cite only), not the guideline text. The summary gives no doses, no schedule, no starting order and no class of recommendation for the four-class statement, so none is recorded and the page does not say the classes are started together. The first component stands for the ARNI class, using the only ARNI record in this atlas as the example; an ACE inhibitor or an angiotensin receptor blocker is the alternative the summary names when an ARNI is not feasible. The id keeps the HFrEF wording of the plan, but the summary states the four classes for heart failure in general, and its own class 1a statements for the first and fourth classes are limited to reduced ejection fraction. No recommendation link is written for the regimen as a whole. PubMed lists three corrections to the guideline; their text was not read.
About this intervention
- Type
- Regimen
- Mechanism
- Four medicine classes that the ACC summary of the 2022 guideline lists as guideline-directed medical therapy; it gives no combined mechanism.
Components
Claims and evidence
Context Patients with current or prior heart failure, any ejection fraction (2022 AHA/ACC/HFSA, as summarized by the ACC)
- Recipient
- Recipient not specified
- Population
- Patients with current or prior heart failure, whatever their ejection fraction, who according to the ACC summary should be considered for guideline-directed therapy. The summary gives no age limits.
- Care setting
- Not stated in the ACC summary.
- Geography
- Not stated in the ACC summary (issued by American societies; jurisdiction not verified)
- Life stage
- Not stated in the ACC summary
- Gestational age
- Not reported
- Postnatal age
- Not reported
- Follow-up
- Not applicable (guideline context)
Eligibility: 1 inclusion criterion; exclusion criteria not stated
- Included
- Current or prior heart failure, at any ejection fraction (to be considered for the therapy)
- Excluded
- None stated
An ACC summary of the 2022 heart failure guideline of the AHA, ACC and HFSA says that guideline-directed medical therapy now has four classes: renin-angiotensin system inhibition (with an angiotensin receptor-neprilysin inhibitor, an ACE inhibitor or an angiotensin receptor blocker), beta blockers, mineralocorticoid receptor antagonists and SGLT2 inhibitors. It says everyone with heart failure now or in the past, whatever their ejection fraction, should be considered for this therapy.
Source problem. A cited source is corrected. Check the sources before relying on this claim.
Applies to Recipient not specified- Patients with current or prior heart failure, whatever their ejection fraction, who according to the ACC summary should be considered for guideline-directed therapy. The summary gives no age limits.
- Not stated in the ACC summary.
- Not stated in the ACC summary (issued by American societies; jurisdiction not verified)
- Not stated in the ACC summary
- Gestational age Not reported
- Postnatal age Not reported
- Certainty method
- Not assessed
- Limitations
- The source is the ACC key-perspectives summary of the guideline (ACC content, hash only), not the guideline text. This is a description of what the therapy consists of and a statement that patients should be considered for it, not a recommendation to use all four classes at every ejection fraction. The statements in the summary itself limit the first-line ARNI statement and the class 1a SGLT2 inhibitor statement to heart failure with reduced ejection fraction, and give SGLT2 inhibitors class 2a in mildly reduced and preserved ejection fraction. It gives no class of recommendation for the four-class statement, no doses and no order of starting, so none is recorded and nothing here says the classes are started together. PubMed lists three corrections to the guideline; their text was not read, so it is not known whether they change anything stated here.
- Last checked
- 2026-10-15
- Next evidence check due
- Not scheduled
Sources and citations (3)
-
- Locator
- Key perspective 2, sentence 1, fragments 1 to 3
- How it applies
- The four classes of guideline-directed medical therapy.
- Retrieved
- Source effective date
- Not reported
- Source state
- Corrected
- Snapshot hash
9bf3f8d91011b793cc049e80db09ae5624271eb6cdb688f5331c7f8aa1556cad- Reuse basis
- PubMed record and ACC page. PubMed record fetched through NCBI E-utilities on 2026-10-15. Only the hash of the bytes is kept; nothing is committed. Bibliographic metadata and short quotations from the PubMed abstract, under 25 words each. The full text was not redistributed and the societies' reuse terms were not reviewed. ACC web page fetched with a plain Mozilla/5.0 user agent on 2026-10-15. Only the hash of the bytes is kept; nothing is committed. The ACC's reuse terms were not read, so public text is cite_only: public pages state the summary in the atlas's own words, with a citation and a link, and use no ACC wording. Quote rows are short evidence fragments for the reviewer.
-
- Locator
- Key perspective 1, last sentence
- How it applies
- Anyone with current or past HF should be considered for this therapy.
- Retrieved
- Source effective date
- Not reported
- Source state
- Corrected
- Snapshot hash
9bf3f8d91011b793cc049e80db09ae5624271eb6cdb688f5331c7f8aa1556cad- Reuse basis
- PubMed record and ACC page. PubMed record fetched through NCBI E-utilities on 2026-10-15. Only the hash of the bytes is kept; nothing is committed. Bibliographic metadata and short quotations from the PubMed abstract, under 25 words each. The full text was not redistributed and the societies' reuse terms were not reviewed. ACC web page fetched with a plain Mozilla/5.0 user agent on 2026-10-15. Only the hash of the bytes is kept; nothing is committed. The ACC's reuse terms were not read, so public text is cite_only: public pages state the summary in the atlas's own words, with a citation and a link, and use no ACC wording. Quote rows are short evidence fragments for the reviewer.
-
- Locator
- CommentsCorrectionsList, three ErratumIn entries
- How it applies
- Shows that corrections exist. What they change is unknown.
- Retrieved
- Source effective date
- Not reported
- Source state
- Corrected
- Snapshot hash
359253a28c2add87ff845ef77e0400c1886971358eacddb04f09833df0707f1f- Reuse basis
- PubMed record and ACC page. PubMed record fetched through NCBI E-utilities on 2026-10-15. Only the hash of the bytes is kept; nothing is committed. Bibliographic metadata and short quotations from the PubMed abstract, under 25 words each. The full text was not redistributed and the societies' reuse terms were not reviewed. ACC web page fetched with a plain Mozilla/5.0 user agent on 2026-10-15. Only the hash of the bytes is kept; nothing is committed. The ACC's reuse terms were not read, so public text is cite_only: public pages state the summary in the atlas's own words, with a citation and a link, and use no ACC wording. Quote rows are short evidence fragments for the reviewer.
Record details
- Record id
cardio:hfref-four-medicine-regimen- Content hash
f380bf36eff217413bf9895b8917398ace607e006a8c49e6547d066902d878f4