What should be prioritized for a patient experiencing symptoms of heart failure despite being on guideline-directed medical therapy (GDMT)?

In a patient experiencing heart failure symptoms despite being on guideline-directed medical therapy (GDMT), prioritizing the increase of the β-blocker dose is particularly important. β-blockers play a crucial role in managing heart failure because they can improve cardiac function, reduce heart rate, and decrease myocardial oxygen demand. This aids in symptomatic relief and overall prognosis in patients with heart failure, particularly those with a reduced ejection fraction.

When titrated to appropriate doses, β-blockers have been shown to decrease mortality and hospitalization rates. Therefore, in the context of a patient whose symptoms persist despite optimized medical therapy, enhancing the dose of the β-blocker can lead to significant clinical benefits and improved management of heart failure.

Increasing the doses of spironolactone or lisinopril might be beneficial depending on the patient's condition and specific circumstances, but they may not have the immediate impact that optimizing β-blocker therapy can provide. Digoxin is typically used in specific cases, such as in patients who remain symptomatic despite optimal doses of GDMT, and discontinuing it may not be considered a priority in this scenario. Hence, focusing on β-blockers is the best strategy when addressing unresolved heart failure symptoms in this context.