Pharmacologic Therapy for Heart Failure With Reduced Ejection Fraction: Closing the Gap Between Clinical Guidelines and Practice

Prog Cardiovasc Dis. 2017 Sep-Oct;60(2):187-197. doi: 10.1016/j.pcad.2017.08.006. Epub 2017 Aug 25.


Despite the great progress made in the management of heart failure (HF) with reduced ejection fraction (HFrEF), its prevalence continues to rise owing to an aging population and an epidemic of hypertension, obesity and coronary artery disease. For decades, angiotensin converting enzyme inhibitors and beta blockers have been the mainstay of HFrEF therapy. The recent addition of sacubitril/valsartan and ivabradine to the HF armamentarium has the potential to transform our therapeutic approach to HFrEF, while simultaneously raising some questions and uncertainties on their applicability. In this paper, we review the pathophysiology of HFrEF, discuss already established and novel evidenced-based pharmacologic therapies available for these patients. We also share some therapeutic strategies aimed to optimize HF therapy in specific undertreated patient populations including the elderly and patients with chronic kidney disease, while offering insight on how to tailor therapy in the "real-world."

Keywords: Guideline directed medical therapy; Heart failure with reduced ejection fraction; Management; Outcomes.

Publication types

  • Review

MeSH terms

  • Cardiovascular Agents / adverse effects
  • Cardiovascular Agents / therapeutic use*
  • Heart Failure / diagnosis
  • Heart Failure / drug therapy*
  • Heart Failure / mortality
  • Heart Failure / physiopathology
  • Humans
  • Patient Selection
  • Practice Guidelines as Topic / standards*
  • Practice Patterns, Physicians' / standards*
  • Professional Practice Gaps / standards*
  • Recovery of Function
  • Renin-Angiotensin System / drug effects
  • Risk Factors
  • Stroke Volume / drug effects*
  • Sympathetic Nervous System / drug effects
  • Sympathetic Nervous System / physiopathology
  • Treatment Outcome
  • Ventricular Function, Left / drug effects*


  • Cardiovascular Agents