Multiple clinical trials evidence the long-term benefits of guideline-directed medical therapy in heart failure (HF), and international guidelines make clear recommendations for its rapid initiation. But this hasn’t translated into optimal treatment for most patients in the real-world. So, what steps can we take to reverse this trend? In this month’s episode, we speak with Dr Tariq Ahmad MD, Chief of Heart Failure at Yale University, and author of several recent behavioural and implementation studies in HF, including REVeAL-HF and PROMPT-HF. In this conversation, we get to grips with the reality of sub-optimal treatment and discuss some possible ways forward using behavioural “nudges” embedded within electronic health records. We also consider the barriers faced in everyday practice that obscure optimal therapy for so many patients. Questions can be sent via Twitter to our host @mvaduganathan or to @radcliffeCARDIO. This podcast is supported by an unrestricted educational grant from AstraZeneca.