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Navigating Common Challenges When Initiating Guideline-directed Medical Therapy for Patients with HFrEF

Clinical Thought

When foundational therapy for heart failure with reduced ejection fraction (HFrEF) entails 4 drug classes, initiating the regimen can be complex. In this commentary, an expert offers recommendations around 3 common sources of confusion: (1) the urgency of starting therapy, (2) whether and how to sequence therapy, and (3) ideal dosing.

In Collaboration With the Academy of Physician Associates in Cardiology


Released: June 14, 2022

Expiration: June 13, 2023

No longer available for credit.



Javed Butler

Javed Butler, MD, MPH, MBA

Baylor Scott and White Research Institute
Dallas, Texas
Distinguished Professor of Medicine
Department of Medicine
University of Mississippi Medical Center
Jackson, Mississippi


This activity is supported by an independent educational grant from Boehringer Ingelheim Pharmaceuticals, Inc. and Eli Lilly and Company.

Target Audience

NPs and PAs


Javed Butler, MD, MPH, MBA: consulting fees: Abbott, Adrenomed, Amgen, Array, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, CVRx, G3 Pharmaceuticals, Impulse Dynamics, Innolife, Janssen, LivaNova, Luitpold, Medtronic, Merck, Novartis, Novo Nordisk, Roche, Vifor.


The opinions or views expressed in this CE/CME activity do not necessarily reflect the opinions or recommendations of Practicing Clinicians Exchange or any educational supporter.

Additional Information

Program Medium

This program has been made available online.