Implementation of guideline-directed medical therapy in patients with heart failure and obesity: European Journal of Heart Failure expert consensus document

Renin-angiotensin system inhibitors (mainly sacubitril-valsartan), MRAs and SGLT2 inhibitors provide consistent benefits across body mass index (BMI) categories, with no major obesity-specific safety concerns (evidence from subgroup analyses of major heart failure (HF) trials)

Data on beta-blockers in obese HF patients remain limited, largely reflecting the older design of pivotal trials

Management should include careful assessment of congestion, acknowledging the limitations of physical examination, and integrate natriuretic peptide measurement and imaging to guide individualised diuretic strategies