Sequencing and Titrating Approach of Therapy in Heart Failure with Reduced Ejection Fraction Following the 2021 ESC guidelines: an International Cardiology Survey

In symptomatic patients with heart failure and reduced ejection fraction (HFrEF), recent international guidelines recommend initiating four major therapeutic classes rather than sequential initiation. However, it remains to be seen how this change in guidelines is perceived by practising cardiologists versus heart failure (HF) specialists. In a broad international cardiology community, the “historical approach” for HFrEF therapies remains the preferred sequencing approach. However, accelerated introduction and up‐titration are also major treatment goals. Strategy trials in treatment guidance are needed to change practices further.