Recommendations
Table 1. Pharmacological Treatment for Stage C HF With Reduced Ejection Fraction: Recommendations
| COR | LOE | Recommendations |
|---|---|---|
| I | The clinical strategy of inhibition of the renin-angiotensin system with: | |
| I | A | ACE inhibitors, OR |
| I | A | ARBs, OR |
| I | B-R | ARNI* |
| I | 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 | The use of ACE inhibitors is beneficial for patients with prior or current symptoms of chronic HFrEF to reduce morbidity and mortality. |
| I | A | The 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. |
* sacubitril/valsartan is the only FDA approved ARNI.
Table 2. Ivabradine: Recommendation
| 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 or greater at rest. |