Management of Heart Failure With Reduced Ejection Fraction |
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| Affiliation: | 1. Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan;2. Division of Cardiology, Duke University School of Medicine, Durham, NC;3. Duke Clinical Research Institute, Durham, NC;4. Division of Clinical Pharmacology, Duke University School of Medicine, Durham, NC;5. Department of Medicine, University of Mississippi Medical Center, Jackson, MS;6. Baylor Scott and White Research Institute, Dallas, TX;1. Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire;2. The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire;3. Duke University Clinical Research Institute, Durham, North Carolina;4. University of California Los Angles, Division of Cardiology, Los Angeles, California;5. Brigham and Women''s Hospital, Division of Cardiovascular Medicine, Boston, Massachusetts;6. Northwestern University, Division of Cardiology, Chicago, Illinois;1. Department of Therapeutics, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece;2. Research Unit of Radiology and Medical Imaging, 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece |
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| Abstract: | Heart failure with reduced ejection fraction (HFrEF) is a complex and progressive clinical condition characterized by dyspnea and functional impairment. HFrEF has a high burden of mortality and readmission rate making it one of the most significant public health challenges. Basic treatment strategies include diuretics for symptom relief and use of quadruple therapy (Angiotensin receptor blocker/neprilysin inhibitors, evidence-based beta-blockers, mineralocorticoid receptor antagonists, and sodium–glucose co-transporter 2 inhibitors) for reduction in hospitalizations, all-cause mortality, and cardiovascular mortality. Despite compelling evidence of clinical benefit, guideline directed medical therapy is vastly underutilized in the real-world clinical practice. Other medications such as intravenous iron, ivabradine, hydralazine/nitrates and vericiguat may also have a role in certain subgroup of HFrEF patients. Specific groups of patients with HFrEF may also be candidates for various device therapies such as implanted cardioverter defibrillators, cardiac resynchronization therapy and trans catheter mitral valve repair. This review provides a comprehensive overview of drug and device management approaches for patients with HFrEF, recommendations for initiation and titrations of therapies, and challenges associated with guideline directed medical therapy in the management of patients with HFrEF (Graphical abstract). |
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