Heart failure with reduced ejection fraction (HFrEF)

Heart failure with reduced ejection fraction (HFrEF) is a condition in which the heart is unable to pump enough blood to meet the body's needs. The American College of Cardiology (ACC) provides detailed guidelines for the pharmacological treatment of HFrEF.

Angiotensin-Converting Enzyme (ACE) Inhibitors or Angiotensin Receptor Blockers (ARBs):

These drugs work to relax blood vessels, decrease blood pressure, and improve blood flow. ACE inhibitors and ARBs are first-line treatments for HFrEF. They are recommended for all patients with HFrEF who can tolerate them, regardless of whether they have symptoms or not.

Beta-Blockers:

Beta-blockers are medications that block the effects of adrenaline on the heart, slowing the heart rate, reducing blood pressure, and improving heart function. They are also first-line treatments for HFrEF and should be used in all patients who can tolerate them.

Mineralocorticoid Receptor Antagonists (MRAs):

MRAs are drugs that block the effects of the hormone aldosterone, which causes the body to retain salt and water. MRAs can reduce fluid buildup in the body, improve heart function, and decrease the risk of hospitalization and death. They are recommended for patients with HFrEF who have symptoms or a history of hospitalization and are not at risk of developing hyperkalemia (high potassium levels in the blood).

Sacubitril/Valsartan:

Sacubitril/valsartan is a combination drug that works by blocking the action of a protein that causes the heart to work harder. It is recommended for patients with HFrEF who have symptoms despite treatment with ACE inhibitors or ARBs.

Ivabradine:

Ivabradine is a medication that reduces the heart rate by blocking the action of a protein that controls the heart's rhythm. It is recommended for patients with HFrEF who have symptoms and a resting heart rate of 70 beats per minute or higher, despite treatment with beta-blockers.

Hydralazine and Isosorbide Dinitrate:

Hydralazine and isosorbide dinitrate are medications that work together to relax blood vessels, improve blood flow, and reduce the workload on the heart. They are recommended for patients with HFrEF who cannot tolerate ACE inhibitors or ARBs.

In summary, the pharmacological treatment of HFrEF according to the ACC guidelines includes ACE inhibitors or ARBs, beta-blockers, MRAs, sacubitril/valsartan, ivabradine, and hydralazine and isosorbide dinitrate. The choice of medication depends on the patient's individual characteristics, including symptoms, comorbidities, and medication tolerability.