[Diagnosis and treatment of heart failure with reduced ejection fraction]

The diagnosis of heart failure with reduced ejection fraction (HFrEF) is based on clinical symptoms, such as peripheral edema or dyspnea and a left ventricular ejection fraction (LVEF) of 40% or less. Treatment is based particularly on the "fantastic four" of renin-angiotensin-aldosterone system (RAAS) inhibitors, preferential angiotensin receptor neprilysin inhibitor (ARNI), beta-blockers, mineralocorticoid receptor antagonists (MRA) and sodium-glucose-linked transporter 2 (SGLT2) inhibitors. These agents have a class I recommendation and show significant benefits in terms of mortality and hospitalization rates. The rapid and complete implementation of the pharmacotherapy substantially improves the prognosis. Additional options, such as ivabradine, vericiguat or digoxin, can be considered if the standard treatment is insufficient. Iron deficiency frequently occurs in HFrEF patients and is associated with increased mortality. Intravenous iron supplementation improves the exercise capacity and reduces hospitalizations.