Heart Failure in Patients With Reduced Ejection Fraction
There are 3 primary issues that must be considered when treating heart failure (HF) patients with reduced left ventricular ejection fraction (LVEF): (1) improving symptoms and quality of life, (2) slowing the progression or reversing cardiac and peripheral dysfunction, and (3) reducing mortality. General measures, such as salt restriction, weight loss, lipid control, and other nonpharmacologic measures are addressed in Section 6. Pharmacologic approaches to symptom control, including diuretics, vasodilators, intravenous inotropic drugs, anticoagulants, and antiplatelet agents are discussed at the end of this section.
Two classes of agents have become the recommended cornerstone of therapy to delay or halt progression of cardiac dysfunction and improve mortality: angiotensin-converting enzyme (ACE) inhibitors and beta blockers. Even while these agents are underused in the treatment of HF, new classes of agents have been added that show an impact on mortality, complicating decisions about optimal pharmacologic therapy. These include angiotensin receptor blockers (ARBs), aldosterone antagonists, and the combination of hydralazine and an oral nitrate, all of which are considered in the following recommendations.