Treatment of Chronic HF with Reduced EF

(Circ 2017;136:e137; JACC 2021;77:772)

• Diuretics | Loop ± thiazides diuretics
  • (sx relief; no mortality benefit)
• RASi ACEI ARB
• β-blocker
• Aldosterone-antagonists
• SGLT2i
• Hydralazine---nitrates
• Ivabradine blocker用不了的時候 (If blocker w/o ⊖ ino)
• Digoxin
• Vericiguat
• Cardiac-resynch-therapy (CRT, qv)
• ICD (see “Cardiac Rhythm Mgmt Devices”)
• Iron-supplementation
• Anticoagulation-Treatment of Chronic HF with Reduced EF

Heart rhythm

If AF & NYHA II-IV w/ EF <35%,

• catheter ablation ↓ D/HF hosp vs. med Rx (rate or rhythm; NEJM 2018;378:417)

BP

• Goal <130/80 (JACC 2018;71:127) 👉 ACC AHA Classification for Office-Based BP

Diet, exercise

? Na <2 g/d, fluid restriction, exercise training in ambulatory Pts

Meds to avoid

NSAIDs, nondihydropyridine CCB, TZDs