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Treatment
Figure 6. Treatment of HFrEF Stages C and D
Step 1
Establish diagnosis
of HFrEF
Address congestion
Initiate GDMT
Step 2
Titrate to target
dosing as tolerated,
labs, health status,
and LVEF
HFrEF
LVEF ≤40%
(Stage C)
LVEF ≤40%
Persistent HFrEF
(Stage C)
NYHA III–IV, in
African American
patients
NYHA I–III;
LVEF ≤35%;
>1 y survival
NYHA II–III;
ambulatory IV;
LVEF ≤35%;
NSR and QRS
≥150 ms with
LBBB
Diuretics
as needed
(1)
ARNi in NYHA
II–III;
ACEi or ARB in
NYHA II–IV
(1)
Beta blocker
(1)
MRA
(1)
SGLT2i
(1)
LVEF >40%
HFimpEF
(Stage C)
Continue GDMT with serial reassessment and optimize dosing,
adherence and patient education, address goals of care
* Participation in investigational studies is appropriate for stage C, NYHA class II and III HF.
