Management of Heart Failure with Reduced Ejection Fraction

Medication Management

• The American Heart Association recommends the use of beta-blockers, such as carvedilol, metoprolol succinate, or bisoprolol, in patients with heart failure with reduced ejection fraction (HFrEF) 2, 3, 4
• The American College of Cardiology recommends the use of aldosterone receptor antagonists, such as spironolactone or eplerenone, in patients with HFrEF and EF ≤35% 2, 3, 4
• The European Society of Cardiology recommends considering sacubitril/valsartan instead of valsartan alone in patients with symptomatic HFrEF despite optimal therapy 4
• Amlodipine is acceptable in HFrEF, but non-dihydropyridine calcium channel blockers, such as diltiazem and verapamil, are contraindicated 2, 3, 1

Monitoring and Follow-up

• Daily weight monitoring is essential to detect fluid shifts, with a target of <2-3 pounds gain in 24 hours 1
• Regular monitoring of serum electrolytes, creatinine, and BUN is necessary, especially during the first few months of treatment 1, 5
• Clinical monitoring should include daily weights, blood pressure, and symptoms of volume overload or depletion 1, 5, 3

Contraindicated Medications

• The American Heart Association recommends avoiding NSAIDs and COX-2 inhibitors, such as ibuprofen and celecoxib, in patients with HFrEF due to the risk of sodium and water retention and worsening heart failure 2, 3, 6
• Thiazolidinediones, such as pioglitazone and rosiglitazone, are contraindicated in HFrEF due to the increased risk of heart failure worsening and hospitalization 6, 1