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

Alanna Morris, MD; Michael Weber, MD; Jeffrey J. Hsu, MD


November 16, 2023

According to a recent Update to the 2017 ACC Expert Consensus Decision Pathway for Optimization of Heart Failure Treatment, initiation of beta-blockers is often better tolerated when the patient is less congested ("dry"), with an adequate resting heart rate, while ARNI/ACEI/ARB is usually better tolerated when the patient is still congested ("wet"). Based on a study of Medicare beneficiaries, patients treated with one of the three evidence-based beta-blockers—carvedilol, bisoprolol, or sustained-release metoprolol succinate—had lower heart failure readmission and mortality rates.

Beta-blockers are recommended by the AHA/ACC/HFSA in all patients when HFrEF is diagnosed, unless contraindicated, to reduce mortality. Therapy should be initiated at a low dose and increased every 2 weeks until the target dose is achieved or until a dose increase is limited.

Beta-blocker use in patients with acute decompensated heart failure has been associated with "acute negative inotropic effects."

Learn more about the treatment of HFrEF.


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