- Heart failure (HF) may occur with either a preserved or a reduced left ventricular ejection fraction. In HF with reduced ejection fraction (HFrEF), a number of medications effectively reduce symptoms, hospitalizations, and the risk of death.
- For patients with chronic, symptomatic HFrEF (NYHA class II or III) who have been on an ACEI (angiotensin converting enzyme inhibitor) or an ARB (angiotensin II receptor blocker), replacing them with sacubitril/valsartan (Entresto ) is recommended to further reduce disability and death.
- For patients with HFrEF who cannot afford or tolerate sacubitril/valsartan, an ACEI or an ARB is the recommended treatment.
- All patients with HFrEF should be treated with 1 of the 3 beta-blockers proven to reduce HF death (unless contraindicated).
- Aldosterone receptor antagonists (ARAs) are recommended to further reduce hospitalizations and death when added to ACEI or ARB therapy.
- The above medications should be titrated slowly to the recommended target dose or, if the target dose is not tolerated, the highest tolerated dose.
- Loop diuretics are recommended in patients who have evidence of fluid overload.
- Ivabradine (Corlanor ) can be added to standard therapy in selected patients to reduce the risk of hospitalization for worsening HF.
- Several medications can potentially worsen HF. All medications, including over-the-counter (OTC) drugs, should routinely be reviewed in patients with HF.
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