Congestive heart failure Pharmacological treatments for patients with heart failure with reduced ejection fraction
Congestive Heart Failure Microchapters |
Pathophysiology |
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Differentiating Congestive heart failure from other Diseases |
Diagnosis |
Treatment |
Medical Therapy: |
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ACC/AHA Guideline Recommendations
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Congestive heart failure Pharmacological treatments for patients with heart failure with reduced ejection fraction On the Web |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mitra Chitsazan, M.D.[2]
Overview
- 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. Unless contraindicated or not tolerated, the sodium-glucose co-transporter 2 (SGLT2) inhibitors (dapagliflozin and empagliflozin) are recommended for all HFrEF patients who are already taking an ACE-I/ARNI, a beta-blocker, and an MRA, regardless of diabetes status.