Jonathan Davis, MD, MPHS

Director @sfhealthnetwork HF Program Zuckerberg SF General Hospital @zsfgcare @ucsfcardiology. New Dad x2! Alum @WUSTLmed⬅️ @UCSFmedicine⬅️ @cornell he/his/him

[Jonathan Davis, MD, MPHS @JonathanDavisHF]

The 3 rules of #GDMTWorks for #HFrEF:
1. Start more
2.⬆️doses
3. Keep them going
#QuadTherapy: BB + ARNI + MRA + SGLT2-I. 75% RR reduction w NNT of <4!! @gcfmd @MKIttlesonMD @AndrewJSauer @AminYehyaMD @mpsotka @DrNasrien @shwinner @ShelleyZieroth @iamritu @DevinMehta @datsunian

[Gregg Fonarow MD @gcfmd]

Is the simultaneous/rapid sequence initiation strategy for GDMT for HFrEF superior to usual care one by one approach?

✅ Better use, dosing, adherence, and persistence

✅ Safe, well tolerated, less HF events

In both the 🏨 and outpatient clinic setting

🎯STRONG-HF
🎯 SHORT

[Gregg Fonarow MD @gcfmd]

Can quadruple GDMT be simultaneously initiated and rapidly uptitrated in ambulatory outpatients with HFrEF?

The SHORT RCT

✅ Time to quadruple GDMT optimization 29 days vs 112 with usual care

✅ safe, well tolerated, less visits, less HF events

https://t.co/bqJRd3DSYs

[Gregg Fonarow MD @gcfmd]

Rosuvastatin 20 mg for primary prevention and achieving LDL < 50 mg/dL

Clinical benefits>>potential risks

Relative risk reductions: large
Absolute risk reductions: small per year, but accumulate over time

Cost:
$31.40 per year
$2.61 per month
9 cents a day

[Ahmed Bennis MD 🫀 @drbennisahmed]

💊🫀 What does optimal therapy actually buy a 65-year-old with HFmrEF/HFpEF?
From Nature Medicine (Vaduganathan et al., 2025):
🔴 SGLT2i + nsMRA → +3.6 years event-free survival
🔴 SGLT2i + nsMRA + ARNI → +4.9 years (LVEF <60%)
vs. standard therapy alone.
Nearly 5 extra years without hospitalization or death.
💡 These drugs exist. They work. Are all eligible patients receiving them?
Vaduganathan et al. Nature Medicine, Oct 2025
@mvaduganathan

#HeartFailure #HFpEF #HFmrEF #SGLT2i #ARNI #Cardiology #MedTwitter #NatureMedicine

[Jonathan Davis, MD, MPHS @JonathanDavisHF]

Every admission = opportunity to improve #GDMTWorks! MD, RN, PharmD, etc; QD-BID labs; vitals 4-6x/day... all hands on deck! Take advantage! Major consequences of stopping or not starting! @SJGreene_md @mvaduganathan @gcfmd @JavedButler1 @UCSFIMChiefs
10.1016/j.jchf.2018.06.011

[European Society of Cardiology Journals @ESC_Journals]

Ten Years Real-World Experience With Sacubitril/Valsartan in Patients With Heart Failure With Reduced Ejection Fraction see @ESC Heart Failure https://t.co/Dvkx3OA6gI

@EJHFEiC @JanBiegus @Ppponikowski #HFA_ESC @hvanspall @ShelleyZieroth @FudimMarat @gcfmd @MarcoMetra @GianluSava #ESCHeartFailure

[Gregg Fonarow MD @gcfmd]

Why are 100% of eligible patients with HFrEF w/o CI or intolerance not receiving quadruple GDMT in 2026?

ARNI+BB+MRA+SGLT2i ➡️

75% ⬇️ all-cause ☠️ (26% ARR, NNT=4, 24 months)

85% ⬇️ HF 🏨 (33% ARR, NNT=3, 24 months)

Extend median survival by 7-11 years

💊 Cost $78/month

[Jonathan Davis, MD, MPHS @JonathanDavisHF]

@evivemmou @UCSFCardiology @CCAD_MHIF @ACCinTouch Love this photo! Sorry I missed you there. Hope you're all doing well!

[Steve Greene @SJGreene_md]

Patients newly diagnosed w/ #HFrEF

&gt;9 of 10 deaths occur among pts who never receive ≥1 💊 proven to ⤵️⤵️⤵️death....

...in a nationwide health system w/ minimal or $0 patient copays for #GDMTworks

🤯🤯🤯

@gcfmd @JavedButler1

https://t.co/S1KBq4eVxG

[Gregg Fonarow MD @gcfmd]

@SJGreene_md @JavedButler1 @DCRINews @AndrewJSauer @AndrewPAmbrosy @ShelleyZieroth @HanCardiomd @ValleAlfonso @drbennisahmed @JLHarrington_MD @ShashankSinhaMD @DukeCardFellows Treatment inertia, misperception of clinical risk, and lack of therapeutic urgency are highly lethal in HFrEF

Take action now!

[Gregg Fonarow MD @gcfmd]

HFrEF in 2026

Most common Rx is use still ACEI/ARB+BB, despite Class 1 recommendation for quadruple GDMT

ACEI/ARB+BB ➡️ ARNI+BB+MRA+SGLTi

Extends median survival:
6.3 years
75.6 months
2300 days
55,188 hours
3,311,280 minutes

💊s cost extra $70 per month

Worth it?

[Amin Yehya, MD, MS, FACC, FHFSA @AminYehyaMD]

Thankful for my coauthors: Jose Lopez, Andrew Sauer, Jonathan Davis, Nasrien Ibrahim, Rod Tung, Biykem Bozkurt, Gregg Fonarow, and Sana Al-Khatib.

Link: https://t.co/ZdT67WJQhz

[Gregg Fonarow MD @gcfmd]

Considerations for Rx beyond the foundational 4 pillars of disease modifying guideline-directed medical therapy for HFrEF

[Jonathan Davis, MD, MPHS @JonathanDavisHF]

Excited to share this news piece about one of our #heartsuccess patients in our Heart Failure Clinic @mercysaintlouis, setting the standard for #heartfailure care in the @STLCounty @STLCityGov region @American_Heart @ACCinTouch @HFSA
https://t.co/9qQhlGeAAx

[Jonathan Davis, MD, MPHS @JonathanDavisHF]

I am speaking at UCSF 29th Annual Management of the Hospitalized Patient. Please check out my talk if you're attending the event! #Bob_Wachter #MHP2025 - via #Whova event app

[Steve Greene @SJGreene_md]

@AndrewFoy82 @gcfmd @mvaduganathan @AndrewJSauer @dranulala @ShelleyZieroth @JavedButler1 @pedschwartzmann @JonathanDavisHF @HFA_President @ankeetbhatt To Mandrola's original point: 🔑is definition of "decompensated"

We should not initiate BB in hemodynamic instability/shock

But "decompensated" is not synonymous w/ entirety of a HF hospitalization.

In-hospital/pre-discharge initiation BB is evidence-based routine approach.

[Henry Han @HanCardiomd]

Semaglutide and Tirzepatide in Patients With Heart Failure With Preserved Ejection Fraction

https://t.co/8Y0G6ZroG8

[Jonathan Davis, MD, MPHS @JonathanDavisHF]

Excited to formally launch our #HeartFailure Clinic at @FollowMercy St. Louis. Offering comprehensive, state-of-the-art, guideline-direct care for anyone with heart failure across the ejection fraction spectrum! #heartfunction #heartsuccess

[Muthu Vaduganathan @mvaduganathan]

β-blockers safe pre-discharge in #HFrEF

#COPERNICUS ☠️ benefit in recent decomp
https://t.co/RPAODKmbNj

#STRONGHF rapid uptritration ⬇️ events
https://t.co/2EGk0obyDg

#IMPACTHF ⬆️ Rx persistence
https://t.co/pc0wJkfY7U

#BCONVINCED stopping not helpful
https://t.co/GdMoEu5qr8

[Jonathan Davis, MD, MPHS @JonathanDavisHF]

9/29 I start at Mercy St. Louis!
Working at @UCSFHospitals/@ZSFGCare/@UCSFCardiology was a profound privilege. The community, patients, &amp; colleagues gave me more than I can ever express. Please know how grateful I am to have been part of this extraordinary team.