Congestive heart failure Pharmacological treatments for patients with heart failure with reduced ejection fraction

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  • The major goals of pharmacologic treatment for patients with HFrEF are:

1) Reducing mortality (either all-cause or CV) 2) Reducing the risk of repeated hospitalizations due to worsening HF 3) Improving clinical status, functional capacity, and QOL

The cornerstone of pharmacologic management of HFrEF is the modulation of the renin-angiotensin-aldosterone (RAAS) and sympathetic nervous systems (i.e., neurohormonal blockade). Angiotensin-converting enzyme inhibitors (ACE-I) or an angiotensin receptor-neprilysin inhibitor (ARNI), beta-blockers, and mineralocorticoid receptor antagonists (MRA) reduce mortality, reduce the risk of repeated HF hospitalizations, and improve symptoms in patients with HFrEF. Thus, a combination of an ACE-I/ARNI, a beta-blocker, and an MRA is recommended as class I therapies for all HFrEF patients unless they are contraindicated or not tolerated. These drugs should be uptitrated to the doses used in the clinical trials or to maximally tolerated doses.

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