Table 11. Pharmacological Therapy for Management of
Stage C HFr EF (continued)
Recommendations
COR
Anticoagulants
Patients with chronic HF with permanent/persistent/paroxysmal
AF and an additional risk factor for cardioembolic stroke should
receive chronic anticoagulant therapya
The selection of an anticoagulant agent should be individualized
Chronic anticoagulation is reasonable for patients with chronic
HF who have permanent/persistent/paroxysmal AF but are
without an additional risk factor for cardioembolic strokea
Anticoagulation is NOT recommended in patients with
chronic HFrEF without AF, a prior thromboembolic event, or
a cardioembolic source
Statins
Statins are NOT beneficial as adjunctive therapy when
prescribed solely for HF
Omega-3 Fatty Acids
Omega-3 PUFA supplementation is reasonable to use as
adjunctive therapy in HFrEF or HFpEF patients
Other
Nutritional supplements as treatment for HF are NOT
recommended in HFrEF
Hormonal therapies other than to correct deficiencies are NOT
recommended in HFrEF
Drugs known to adversely affect the clinical status of patients
with HFrEF are potentially harmful and should be avoided or
withdrawn
Long-term use of an infusion of a positive inotropic drug is NOT
recommended and may be harmful except as palliation
Calcium Channel Blockers
Calcium channel–blocking drugs are NOT recommended as
routine treatment in HFrEF
a
LOE
I
A
I
IIa
C
B
III: No
Benefit
B
III: No
Benefit
A
IIa
B
III: No
Benefit
III: No
Benefit
III:
Harm
B
C
B
III:
Harm
C
III: No
Benefit
A
In the absence of contraindications to anticoagulation.
Table 12. Medical Therapy for Stage C HFr EF:
Magnitude of Benefit Demonstrated in RCTs
GDMT
RR Reduction NNT for Mortality
in Mortality, %
Reduction
RR Reduction in HF
Hospitalizations, %
ACE inhibitor or ARB
17
26
31
Beta blocker
34
9
41
Aldosterone antagonist
30
6
35
Hydralazine & nitrate
43
7
33
Adapted from Fonarow GC, et al. Am Heart J. 2011;161:1024-1030.
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