Heart failure with reduced ejection fraction (HFrEF)
- Start 4 disease-modifying pillars early
- ARNI/ACEi/ARB
- evidence-based beta blocker
- MRA + SGLT2 inhibitor
- Titrate in parallel, not serially
- Loop diuretic treats congestion, not survival
- Ivabradine/vericiguat for selected residual risk
Use at a glance
- Start 4 disease-modifying pillars early
- ARNI/ACEi/ARB
- evidence-based beta blocker
- MRA + SGLT2 inhibitor
Practical pearls
- Titrate in parallel, not serially
Other practical pearls
- Loop diuretic treats congestion, not survival
Choosing treatment
- Ivabradine/vericiguat for selected residual risk
Pearls
- Beta blockers: start low; full benefit may take months
- Early beta-blocker worsening often managed with more diuretic
- SGLT2i: dose mornings; small early eGFR dip is expected
- Loop diuretics relieve edema fastest; watch potassium, renal function
Self-check
- What role do loop diuretics have in HFrEF?
Treat congestion, not improve survival. - How should HFrEF therapies be titrated?
In parallel, not serially.
Drugs used for this (28)
All clinical uses · Open Heart failure with reduced ejection fraction (HFrEF) in the interactive console ↗