Heart failure & cardiomyopathies

Nurse led titration of guideline-directed medical therapy for heart failure: an operative flow chart

ESC Heart FailPublished article describes the operational aspects required to implement a nurse-led guideline-directed medical therapy (GDMT) titration program

Authors' conclusion

A multi-professional strategy to manage HF patients involving nurse-led titration of GDMT for HF is suggested as a possible way to improve guideline uptake in real-world practice. This paper aims to describe how to implement it in daily practice in countries such as Italy, where nurse-led titration is not yet standard of care.

Study context

Population
Patients with heart failure (HF) receiving guideline-directed medical therapy (GDMT), Italy
Methodological detailsoperational flow chart, Italian medical-legal aspects are also discussed
  • Operational flow chart
  • Italian medical-legal aspects are also discussed

Further findings

Prerequisites for nurse-led GDMT titration

The main prerequisites are dedicated training and the adoption of management protocols, which, pending national educational plans and protocols, should start at the level of local institutions
Complemented by detailed medical prescriptions specifying, for each patient, the timing and methods of titration, any other assessments to be performed, and the resulting actions

Original publication

Nurse led titration of guideline-directed medical therapy for heart failure: an operative flow chart. ESC Heart Fail. Published 6 October 2026. doi:10.1093/eschf/xvag223

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