Fast Five Quiz: Heart Failure With Reduced Ejection Fraction (HFrEF)

Yasmine S. Ali, MD


June 10, 2021

A beta-blocker should be part of the therapeutic regimen for any patient with symptomatic HFrEF. Diuretics should be used on an as-needed basis to relieve the signs and symptoms of congestion.

In conjunction with an evidence-based beta-blocker, the ACC recommends that patients with symptomatic HFrEF receive an angiotensin-converting enzyme inhibitor (ACEI), an angiotensin receptor blocker (ARB), or an angiotensin receptor-neprilysin inhibitor (ARNI). The role of ARNI in guideline-directed medical therapy for HF has increased, and treatment with an ARNI may now be initiated without first starting an ACEI or ARB.

They also recommend the use of an l f current inhibitor to reduce HF hospitalization for patients with symptomatic, stable, chronic HFrEF who are receiving guideline-directed evaluation and management, including the maximum tolerated dose of beta-blocker, and who are in sinus rhythm, with a heart rate ≥ 70 beats/min at rest.

The treatment algorithm recommended by the ESC for patients with symptomatic HFrEF starts with dual treatment using an ACEI and a beta-blocker.

Mineralocorticosteroid receptors should be added for patients who are still symptomatic despite baseline therapy and whose LVEF is ≤ 35%. If patients are still symptomatic with reduced LVEF, an ARNI may replace the ACEI for patients able to tolerate an ACEI. Patients in sinus rhythm with a heart rate ≥ 70 beats/min can be treated with an l f current inhibitor.

Learn more about guideline-directed pharmacotherapy in HFrEF.


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