18
NYHA class II–IV, provided est.
CrCl >30 mL/min & K+ <5.0 mEq/L
ACEI or ARB AND
GDMT beta
blocker; diuretics
as needed
(COR I)
HFrEF
NYHA class I–IV
(Stage C)
Step 1:
Establish Dx of HFrEF;
assess volume;
initiate GDMT
Step 2:
Consider the following patient
scenarios
NYHA class II–III HF
Adequate BP on ACEI or ARB
*
;
No C/I to ARB or sacubitril
NYHA class III–IV,
in black patients
NYHA class II–III, LVEF ≤35%;
(caveat: >1 y survival, >40 d post MI)
NYHA class II–IV, LVEF ≤35%,
NSR & QRS ≥150 ms with
LBBB pattern
NYHA class II–III, NSR,
heart rate ≥70 bpm on maximally
tolerated dose beta blocker
Treatment
Colors correspond to COR/LOE Table. For all medical therapies, dosing should be optimized and
serial assessment exercised.
*
See text for important treatment directions.
†
Hydral-Nitrates green box: e combination of ISDN/HYD with ARNI has not been robustly
tested. BP response should be carefully monitored.
‡
See 2013 HF guideline.
§
Participation in investigational studies is also appropriate for stage C, NYHA class II and III HF.
Continue GDMT with serial reassessment & optimized dosing/adherence
Figure 2. Treatment of HFr EF Stage C and D (2017)
