Table 12: Potential scenarios in which evidence-based medical therapy for heart failure might be withdrawn

Table 1: New York Heart Association functional classification and other symptom descriptors
Clinical Presentation Conditions to justify stepwise withdrawal of GDMT after 6-12 months of full medical therapy Comments
Tachycardia-related CM
  • Normal EF + LV volumes
  • NYHA I
  • Underlying tachycardia controlled
 Usually due to atrial fibrillation/flutter with increased HR, might rarely occur because of PVCs. Might need long-term BB for rate control
Alcoholic CM
  • Normal EF + LV volumes
  • NYHA I
  • Abstinence ETOH
 Nutritional deficiency, obesity and obstructive sleep apnea might coexist and require therapy
Chemotherapy-related CM
  • Normal EF + LV volumes
  • NYHA I
  • No further drug exposure
 Certain types of chemotherapy are more likely to reverse than others (trastuzumab—high rate of LVEF improvement when it is discontinued whereas patients who received anthracyclines should continue LV enhancement therapy) Long-term surveillance strongly recommended
Peripartum CM
  • Normal EF + LV volumes
  • NYHA I
 Repeat pregnancy might be possible for some. Consultation at high-risk maternal centre should be undertaken
Valve replacement surgery
  • Normal EF + LV volumes
  • NYHA I
  • Normally functioning valve
 Less consensus on regurgitant lesions with ongoing dilation of LV
BB, β-blocker;
CM, cardiomyopathy;
EF, ejection fraction;
ETOH, ethanol;
FC, functional class;
GDMT, guideline-directed medical therapy;
HR, heart rate;
LV, left ventricle;
LVEF, left ventricular EF;
NYHA, New York Heart Association;
PVC, premature ventricular contraction.