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HFpEF HFrEF
THERAPY
Goals
• Control symptoms
• Improve HRQOL
• Prevent
hospitalization
• Prevent mortality
Strategies
• Identification of
comorbidities
Treatment
• Diuresis to relieve
symptoms of
congestion
• Follow guideline-
driven indications
for comorbidities,
eg, hypertension,
AF, CAD, diabetes
mellitus
• Revascularization or
valvular surgery as
appropriate
THERAPY
Goals
• Control symptoms
• Patient education
• Prevent hospitalization
• Prevent mortality
Drugs for routine use
• Diuretics for fluid
retention
• ACEI or ARB
• Beta blockers
• Aldosterone antagonists
Drugs for use in selected
patients
• Hydralazine and
isosorbide dinitrate
• ACEI and ARB
• Digitalis
• ARNI
• Ivabridine
In selected patients
• CRT
• ICD
• Revascularization or
valvular surgery as
appropriate
THERAPY
Goals
• Control symptoms
• Improve HRQOL
• Reduce hospital
readmissions
• Establish patient's
end-of-life goals
Options
• Advanced care
measures
• Heart
transplantation
• Chronic inotropes
• Temporary or
permanent MCS
• Experimental
surgery or drugs
• Palliative care and
hospice
• ICD deactivation
STAGE C
Structural heart disease with
prior or current symptoms of HF
STAGE D
Refractory HF
eg, Patients with:
• Known structural heart disease
and
• HF signs and symptoms
eg, Patients with:
• Marked HF
symptoms at rest
• Recurrent
hospitalizations
despite GDMT
Refractory
symptoms of HF
at rest, despite
GDMT
Heart Failure
