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Feature Article

How to optimise therapy for heart failure with reduced ejection fraction

Andrew Sindone, ANDREA DRISCOLL

Figures

© SERGEY FURTAEV/SHUTTERSTOCK MODEL USED FOR ILLUSTRATIVE PURPOSES ONLY
© SERGEY FURTAEV/SHUTTERSTOCK MODEL USED FOR ILLUSTRATIVE PURPOSES ONLY

Abstract

The prognosis for patients with heart failure is poor, with high rates of hospitalisation and mortality. It is essential to optimise pharmacotherapy and device therapies that improve the prognosis for patients with heart failure with reduced ejection fraction.

Key Points

  • Pharmacotherapy for heart failure with reduced ejection fraction principally comprises ACE inhibitors or angiotensin receptor blockers (ARBs), followed by beta blockers, mineralocorticoid receptor antagonists and angiotensin receptor-neprilysin inhibitors (ARNIs).
  • These medications should be uptitrated to target doses to achieve optimal benefit.
  • ARBs should be considered only for patients who are intolerant of ACE inhibitors.
  • ARNIs are indicated if patients with heart failure remain symptomatic despite treatment with an ACE inhibitor or ARB.
  • Several devices, including implantable cardioverter defibrillators and left ventricular assist devices, have also been shown to improve outcomes in patients with heart failure.
  • Patients who have been hospitalised with heart failure should be reviewed by their GP, cardiologist and heart failure nurse within seven days of discharge.

Figures

© SERGEY FURTAEV/SHUTTERSTOCK MODEL USED FOR ILLUSTRATIVE PURPOSES ONLY
© SERGEY FURTAEV/SHUTTERSTOCK MODEL USED FOR ILLUSTRATIVE PURPOSES ONLY