[Therapy of Heart Failure with Reduced Ejection Fraction: What's New in the 2021 Guidelines?]

Area of Science:

• Cardiology
• Clinical Guidelines
• Pharmacology

Background:

• Treatment options for heart failure with reduced ejection fraction (HFrEF) have significantly advanced.
• The European Society of Cardiology (ESC) released updated guidelines in 2021.

Purpose of the Study:

• To outline the new treatment algorithm for HFrEF patients based on the 2021 ESC guidelines.
• To define the roles of current drugs, interventions, and devices in HFrEF management.

Main Methods:

• Review of the 2021 ESC guidelines for HFrEF.
• Discussion of foundational four-drug therapy and additional treatment strategies.
• Analysis of drug mechanisms, interventions, and device roles.

Main Results:

• A new standard of care involves a foundational therapy of four drug classes for all HFrEF patients.
• This includes an angiotensin-converting enzyme inhibitor, a betablocker, a mineralocorticoid antagonist, and a sodium-glucose co-transporter-2 inhibitor.
• Further treatment adjustments are guided by patient response to maximally tolerated doses and clinical presentation.

Conclusions:

• The 2021 guidelines establish a comprehensive, multi-drug approach for HFrEF.
• Individualized therapy, building on the foundational regimen, is key to optimizing patient outcomes.
• Practical aspects of implementing these new guidelines are discussed.