Practical Guidance on Implementation of Guideline-Directed Medical Therapy in the Management of Heart Failure: Expert Opinion From the Middle East and Africa Region

The 2023 focused update of the European Society of Cardiology 2021 guidelines reviewed the latest scientific evidence and provided recommendations for the guideline-directed medical therapy for the treatment of heart failure. The class IA level of recommendation for SGLT2i (sodium-glucose co-transporter-2 inhibitor) in heart failure with mildly reduced and preserved left ventricular ejection fraction is of considerable relevance in clinical practice. With a marked increase in the overall burden of heart failure and associated risk factors in the Middle East and Africa region, it is crucial to devise a standardized plan for diagnosis and treatment that accounts for epidemiological nuances, the current evidence on newer treatments, and the health care infrastructure available in the region. A group of 45 cardiologists, moderated by 9 experts from the Middle East and Africa region, reviewed the 2023 focused update of the European Society of Cardiology 2021 guidelines in the context of the current state of guideline-directed medical therapy-guided clinical practice. The experts also shared their perspectives on challenges and strategies to overcome for a successful implementation of guideline-directed medical therapy, particularly SGLT2i, in line with the focused update, for management of heart failure in their respective region/country. Here we present (1) a brief review of the existing literature on the latest burden of disease from the region, (2) a short overview of diagnosis and clinical characteristics of heart failure, (3) a review of the clinical evidence leading to the 2023 update of the European Society of Cardiology 2021 guidelines, and (4) a discussion of the current state and opportunities for implementation of guideline-directed medical therapy-guided clinical practice in the region.