The implementation of guideline-directed medical therapy (GDMT) in heart failure (HF) has many challenges in real-world clinical practice. The consensus document is written considering the variability of the clinical presentation of HF patients. HF medical therapies need frequent dose adjustment during hospital admission or when patients develop electrolyte imbalance, acute kidney injury, and other acute illnesses. The paper describes clinical scenarios and graphs that will aid the managing physicians in decision-making for HF therapy optimization.

Background: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition with significant economic burden, morbidity, and mortality rates worldwide. In the Kingdom of Saudi Arabia (KSA), 4.2% of adults 40 years and older have COPD, with a higher prevalence in men and older populations. Key risk factors include smoking, air pollution, occupational exposures, and genetics. COPD coexists with cardiovascular disease (CVD) often, making diagnosis and management more difficult. This study proposes two referral algorithms to optimize care for COPD patients with coexisting CVD in the KSA. Methods: A nine-member cardiopulmonary task force reviewed pertinent literature, guidelines, and held virtual meetings from April to August 2025. Every algorithmic component was iteratively refined; consensus was reached when at least 80% of participants agreed, and items not reaching this threshold were revised until full agreement was reached. Results: According to the cardiology-to-pulmonology algorithm, patients who have unidentified respiratory symptoms or COPD risk factors undergo spirometry assessment and, if confirmed, are referred to pulmonology for diagnostic confirmation, phenotyping, and treatment, including triple fixed-dose combination therapy (TFDC) when necessary. On the other hand, the pulmonology-to-cardiology algorithm directs the evaluation of CVD risk factors and comorbidities using clinical evaluation, electrocardiogram, echocardiography, and biomarker testing, for cardiology referral. Conclusions: By establishing bidirectional referral pathways, morbidity and healthcare burden can be decreased, early detection can be improved, and multidisciplinary management can be strengthened. Future research should assess the feasibility, cost-effectiveness, and real-world impact within KSA’s healthcare system.

The Coronavirus disease 2019 (COVID-19) pandemic led to global and national rapid health system changes to treat the affected patients and prevent the spread of the virus. The social distancing, redirecting resources, and nationwide lockdown led to the cancellation of non-urgent hospital visits and interruption of continuity of care for patients with chronic cardiac conditions such as heart failure (HF). This consensus document addresses the domains of health care delivery that are affected by the pandemic. It explains the current situation of health care delivery to heart failure patients and further recommendation on how to overcome this. Thus, maintaining quality and continuity of care to the HF population.

The prevalence of heart failure (HF) has increased, coinciding with the increase in the prevalence of cardiovascular risk factors such as diabetes, hypertension, and obesity. With the improvement in corrective surgeries for congenital heart disease (CHD), patients are living longer, and around 40% of the CHD population will develop HF later in life. Cardiomyopathies in adults and pediatrics are becoming recognized with advancements in cardiac imaging and family screening. However, HF remains a progressive disease, and a portion of these patients will reach end-stage HF that will require advanced HF therapies, including implanting left ventricle assist devices (LVAD) and heart transplantation (HT). The evolving mechanical circulatory support (MCS) technology, including LVADs, has helped manage patients with advanced HF and acute HF in adults and pediatric patients. The MCS registries have shown improved survival over the past two decades with reduced risk of adverse events. Moreover, emerging experiences are arising for unique uses of LVADs in hypertrophic and restrictive cardiomyopathies, CHD, and small children. The following chapter will highlight the importance of timely patient selection for LVAD therapies in adult and pediatric populations. Further, the challenges associated with the long-term management of these patients will be discussed.