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converting enzyme inhibitors (ACE-Is)/angiotensin II receptor blockers (ARBs), beta-blockers, and mineralocorticoid receptor antagonists (MRAs) for HFrEF. Since 2013, there have been further advances in the management of patients with HF. Class I recommendations have now been presented for the use of angiotensin receptor–neprilysin inhibitors (ARNIs) and sodium– glucose co-transporter 2 inhibitors (SGLT2-Is) in HFrEF. Furthermore, there are now data to support Class I recommendations for the use of SGLT2-Is and MRAs in HFpEF. Although these foundational therapies are crucial to improving the prognosis in HF, many other pharmacotherapies have guideline recommendations, e.g. ivabradine, vericiguat, cardiac glycosides, and, more recently, glucagon-like peptide-1 receptor agonists (GLP-1 RAs). All of these therapies could be viewed as GDMT but are currently not included in the definition of GDMT. Furthermore, the use of the term GDMT ignores the crucial role of devices that work in synergy with medical therapy and new procedural therapies with effect on patient-reported outcomes, morbidity and mortality. The current Task Force has decided to introduce new classifications to describe medical, device, and procedural therapies in HF (Figure 3). These classifications are designed to be dynamic, so the terms can remain contemporary over time as new therapies may be easily incorporated into the terms. Foundational medical therapy (FMT) constitutes the foundation of any HF management. Foundational medical therapy is defined as medical therapy with a guideline Class I recommendation for the treatment of the general HF population, with convincing evidence of an improvement in morbidity and/or mortality. In this guideline, FMT will include beta-blocker, ACE-I/ARNI/ARB, MRA, and SGLT2-I for HFrEF, and MRA and SGLT2-I for HFpEF. The term ‘optimal FMT’ may be used for FMT at the highest tolerated doses according to the guideline-recommended target doses (see Section 6.1). Medical therapies with a Class I recommendation only for specific subsets of patients with HF are not included in the definition of FMT.

Additional medical therapy (AMT) is defined as all other medical therapies that receive a Class IIa/IIb recommendation OR a Class I recommendation with proven effect only on symptoms and/or quality of life (QoL) OR a Class I recommendation in specific subsets of patients/HF phenotypes. Guideline-directed medical therapy therefore covers both FMT and AMT. Guideline-directed interventional therapy (GDIT) includes all cardiac implantable electronic devices (CIED) and interventional therapies that have a recommendation in the guidelines.



 



  

 




Figure 3 New nomenclature for heart failure therapies. Guideline-directed medical therapy (GDMT) includes foundational medical therapy (FMT) and additional medical therapy (AMT). Guideline directed interventional therapy is abbreviated as GDIT. Downloaded from academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehag100/8766302 by guest on 31 August 2026