Heart Failure with Reduced Ejection Fraction Management

Core Disease-Modifying Therapy

The American College of Cardiology recommends using ACE inhibitors in all patients with significantly reduced left ventricular ejection fraction unless contraindicated, with Class I, Level A evidence, for patients with heart failure with reduced ejection fraction (HFrEF) 2
The European Society of Cardiology guidelines support the use of Beta-blockers in all patients with reduced ejection fraction to prevent symptomatic heart failure and reduce mortality, with Class I, Level A evidence, for patients with HFrEF 5
The American College of Cardiology suggests that Angiotensin receptor blockers (ARBs) serve as alternatives for patients who cannot tolerate ACE inhibitors, for patients with HFrEF 4
The European Heart Journal recommends target doses of medications proven effective in randomized controlled trials for each medication class, for patients with HFrEF 6

The American College of Cardiology, American Heart Association, and Heart Failure Society of America guidelines agree on the core medications for HFrEF treatment, with only minor differences in level of evidence assignments, for patients with HFrEF 1
The European Heart Journal suggests monitoring renal function and electrolytes closely, especially when combining RAAS inhibitors with MRAs, for patients with HFrEF 6
The American College of Cardiology recommends implantable cardiac defibrillators for patients with LVEF ≤30% for primary prevention of sudden cardiac death, for patients with HFrEF 7