Treatment
Table 11. Recommendations for Pharmacological Therapy
for Management of Stage C HFr EF
Recommendations
Diuretics
Diuretics are recommended in patients with HFrEF with fluid
retention
ACE Inhibitors
ACE inhibitors are recommended for all patients with HFrEF
ARBs
ARBs are recommended in patients with HFrEF who are ACE
inhibitor–intolerant
ARBs are reasonable as alternatives to ACE inhibitors as first-line
therapy in HFrEF
Addition of an ARB may be considered in persistently
symptomatic patients with HFrEF on GDMT
Routine combined use of an ACE inhibitor, ARB, and
aldosterone antagonist is potentially harmful
Beta Blockers
Use of 1 of the 3 beta blockers proven to reduce mortality is
recommended for all stable patients
Aldosterone Receptor Antagonists
Aldosterone receptor antagonists are recommended in patients
with NYHA class II–IV HF who have LVEF ≤35%
Aldosterone receptor antagonists are recommended in patients
following an acute MI who have LVEF ≤40% with symptoms of
HF or diabetes mellitus
Inappropriate use of aldosterone receptor antagonists may be
harmful
Hydralazine and Isosorbide Dinitrate
The combination of hydralazine and isosorbide dinitrate is
recommended for African Americans with NYHA class III–IV
HFrEF on GDMT
A combination of hydralazine and isosorbide dinitrate can
be useful in patients with HFrEF who cannot be given ACE
inhibitors or ARBs
Digoxin
Digoxin can be beneficial in patients with HFrEF
18
COR
LOE
I
C
I
A
I
A
IIa
A
IIb
A
III:
Harm
C
I
A
I
A
I
B
III:
Harm
B
I
A
IIa
B
IIa
B
