20
Treatment
Table 12. Recommendations for Pharmacological Therapy
for Management of Stage C HFr EF
Recommendations COR LOE
Diuretics
Diuretics are recommended in patients with HFrEF with fluid
retention
I C
ACE Inhibitors
ACE inhibitors are recommended for all patients with HFrEF I A
ARBs
ARBs are recommended in patients with HFrEF who are ACE
inhibitor–intolerant
I A
ARBs are reasonable as alternatives to ACE inhibitors as first-line
therapy in HFrEF
IIa A
Addition of an ARB may be considered in persistently
symptomatic patients with HFrEF on GDMT
IIb A
Routine combined use of an ACE inhibitor, ARB, and
aldosterone antagonist is potentially harmful
III:
Harm
C
Beta Blockers
Use of 1 of the 3 beta blockers proven to reduce mortality is
recommended for all stable patients
I A
Aldosterone Receptor Antagonists
Aldosterone receptor antagonists are recommended in patients
with NYHA class II–IV HF who have LVEF ≤35%
I A
Aldosterone receptor antagonists are recommended in patients
following an acute MI who have LVEF ≤40% with symptoms of
HF or diabetes mellitus
I B
Inappropriate use of aldosterone receptor antagonists may be
harmful
III:
Harm
B
Hydralazine and Isosorbide Dinitrate
The combination of hydralazine and isosorbide dinitrate is
recommended for African Americans with NYHA class III–IV
HFrEF on GDMT
I A
A combination of hydralazine and isosorbide dinitrate can
be useful in patients with HFrEF who cannot be given ACE
inhibitors or ARBs
IIa B
Digoxin
Digoxin can be beneficial in patients with HFrEF IIa B
