34
Treatment
Table 14. Drugs Commonly Used for HFrEF (Stage C HF)
Drug
Initial Daily
Dose(s) Target Doses(s)
Mean Doses
Achieved in
Clinical Trials
I
f
Channel inhibitor
Ivabradine 5 mg twice daily 7.5 mg twice daily 12.8 total daily
Soluble guanylate cyclase stimulator
Vericiguat 2.5 mg once daily 10 mg once daily 9.2 mg total daily
Digoxin 0.125–0.25 mg
daily (modified
according to
monogram)
Individualized
variable dose
to achieve
serum digoxin
concentration
0.5–<0.9 ng/mL
NA
(cont'd)
Table 15. Benefits of Evidence-Based Therapies for Patients
With HFrEF
Evidence-Based
Therapy
Relative Risk
Reduction
in All-Cause
Mortality in
Pivotal RCTs,
%
NNT to
Prevent
All-Cause
Mortality
Over Time*
NNT for
All-Cause
Mortality
(Standardized
to 12 mo)
NNT for
All-Cause
Mortality
(Standardized
to 36 mo)
ACEi or ARB 17 22 over 42 mo 77 26
ARNi
†
16 36 over 27 mo 80 27
Beta blocker 34 28 over 12 mo 28 9
Mineralocorticoid
receptor
antagonist
30 9 over 24 mo 18 6
SGLT2i 17 43 over 18 mo 63 22
Hydralazine or
nitrate
‡
43 25 over 10 mo 21 7
CRT 36 12 over 24 mo 24 8
ICD 23 14 over 60 mo 70 23
* Median duration follow-up in the respective clinical trial.
†
Benefit of ARNi therapy incremental to that achieved with ACEi therapy. For the other
medications shown, the benefits are based on comparisons to placebo control.
‡
Benefit of hydralazine-nitrate therapy was limited to African American patients in this trial.
