22
Table 13. Pharmacological Treatment for Stage C HF With
Reduced Ejection Fraction: Recommendations
(2017)
COR
LOE Recommendations
I e clinical strategy of inhibition of the renin-angiotensin system with:
A ACE inhibitors, OR
A ARBs, OR
B-R ARNI
in conjunction with evidence-based beta blockers, and aldosterone antagonists
in selected patients, is recommended for patients with chronic HFrEF to
reduce morbidity and mortality.
I A e use of ACE inhibitors is beneficial for patients with prior or
current symptoms of chronic HFrEF to reduce morbidity and
mortality.
I A e use of ARBs to reduce morbidity and mortality is recommended
in patients with prior or current symptoms of chronic HFrEF who are
intolerant to ACE inhibitors because of cough or angioedema.
I B-R In patients with chronic symptomatic HFrEF NYHA class II or III
who tolerate an ACE inhibitor or ARB, replacement by an ARNI is
recommended to further reduce morbidity and mortality.
III:
Harm
B-R ARNI should not be administered concomitantly with ACE inhibitors
or within 36 hours of the last dose of an ACE inhibitor.
III:
Harm
C-EO ARNI should not be administered to patients with a history of
angioedema.
Table 14. Ivabradine: Recommendation (2017)
COR
LOE Recommendation
IIa B-R Ivabradine can be beneficial to reduce HF hospitalization for patients
with symptomatic (NYHA class II-III) stable chronic HFrEF
(LVEF ≤35%) who are receiving GDEM, including a beta blocker at
maximum tolerated dose, and who are in sinus rhythm with a heart
rate of ≥70 bpm at rest.
Treatment
