21
Table 12. Pharmacological Therapy for Management of
Stage C HFr EF (continued)
Recommendations COR LOE
Anticoagulants
Patients with chronic HF with permanent/persistent/paroxysmal
AF and an additional risk factor for cardioembolic stroke should
receive chronic anticoagulant therapy
a
I A
The selection of an anticoagulant agent should be individualized I C
Chronic anticoagulation is reasonable for patients with chronic
HF who have permanent/persistent/paroxysmal AF but are
without an additional risk factor for cardioembolic stroke
a
IIa B
Anticoagulation is NOT recommended in patients with
chronic HFrEF without AF, a prior thromboembolic event, or
a cardioembolic source
III: No
Benefit
B
Statins
Statins are NOT beneficial as adjunctive therapy when
prescribed solely for HF
III: No
Benefit
A
Omega-3 Fatty Acids
Omega-3 PUFA supplementation is reasonable to use as
adjunctive therapy in HFrEF or HFpEF patients
IIa B
Other
Nutritional supplements as treatment for HF are NOT
recommended in HFrEF
III: No
Benefit
B
Hormonal therapies other than to correct deficiencies are NOT
recommended in HFrEF
III: No
Benefit
C
Drugs known to adversely affect the clinical status of patients
with HFrEF are potentially harmful and should be avoided or
withdrawn
III:
Harm
B
Long-term use of an infusion of a positive inotropic drug is NOT
recommended and may be harmful except as palliation
III:
Harm
C
Calcium Channel Blockers
Calcium channel–blocking drugs are NOT recommended as
routine treatment in HFrEF
III: No
Benefit
A
a
In the absence of contraindications to anticoagulation.
