A practical guide for the treatment of symptomatic heart failure with reduced ejection fraction (HFrEF)

Abstract

This review will outline the management of patients with symptomatic systolic heart failure or heart failure with reduced ejection fraction (HFrEF), i.e., those with structural heart disease and previous or current symptoms. Determination of volume status and appropriate diuretic administration is important in heart failure management. Inhibition of the renin-angiotensin-aldosterone and sympathetic nervous systems improves survival and decreases hospitalizations in patients with systolic or reduced ejection fraction HF (HFrEF). Beta blockers and aldosterone antagonists improve ejection fraction. Indications for additional agents including nitrates plus hydralazine, digoxin, statins, omega 3 polyunsaturated fatty acids, anticoagulants, and antiarrhythmics will be discussed. Choice of agents, dose-related effects, strategies to minimize adverse effects, and medications to avoid will be presented.

Fig. (1)

Neurohormonal Activation in Heart Failure.

Fig. (2)

Algorithm for management of patients with symptomatic HFrEF. *NYHA Class I and previous myocardial infarction † NYHA Class II-IV ACE-I = ACE inhibitor, ARB = angiotensin receptor blocker, ASA = aspirin, BNP = brain natriuretic peptide, CAD = coronary artery disease, CrCL = creatinine clearance, DM = diabetes mellitus, EF = ejection fraction, GDT = goal-directed therapy, LV = left ventricular, MI = myocardial infarction, MRI = magnetic resonance imaging, NYHA = New York Heart Association, PUFA = polyunsaturated fatty acid, VAD = ventricular assist device.