Is there a role of maximizing GDMT medications for patients with durable VADs?

Yes. There is a role both to (1) reduce morbidity and mortality in patients with heart failure supported with durable LVADs and (2) the potential to promote myocardial recovery concomitantly with mechanical unloading provided by the LVAD. There is no published, prospective, RCT outcomes data yet to support heart failure GDMT use in patients with LVADs, but there are multiple retrospective, observational datasets in which this has been observed. Specifically, if patients who receive LVAD support are pre-identified as possible a higher likelihood for myocardial recovery. these patients should be offered maximally tolerated GDMT to help optimize the likelihood of recovery and even consideration of LVAD explantation.