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

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


March 13, 2023

According to the 2021 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 — the opposite of an ARNI/ACEI/ARB, which is frequently better tolerated when the patient is still congested. Patients with no or minimal signs of volume overload should be treated with one of the three evidence-based beta-blockers: carvedilol, bisoprolol, and sustained-release metoprolol succinate.

Beta-blockers are recommended by the AHA/ACC/HFSA in all patients when HFrEF is diagnosed, unless contraindicated, to reduce mortality and hospitalization. Therapy should be initiated at a low dose and doubled at intervals of ≥ 2 weeks until the target dose is achieved or until a dose increase is limited owing to symptoms because the benefit of beta-blockers appears to be dose-dependent.

Learn more about the treatment of HFrEF.


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