Drug treatment of chronic heart failure with reduced ejection fraction

Heart failure (HF) is a progressive clinical syndrome characterised by insufficient cardiac output due to structural and functional abnormalities of the heart, which can then lead to breathlessness, fatigue and fluid overload. HF has an associated high morbidity and mortality rate as well as a significant impact on healthcare resources; for example, in the UK, it accounts for 5% of National Health Service (NHS) emergency admissions. This review focuses on pharmacological treatment of chronic HF with reduced ejection fraction (HFrEF), which affects approximately 60% of patients with HF. Patient outcomes are determined by early diagnosis and individualised treatment. The cornerstone of HFrEF management consists of four key medication classes: ACE inhibitors or angiotensin receptor-neprilysin inhibitor (ARNI), beta-blockers, mineralocorticoid receptor antagonists (MRA) and sodium-glucose co-transporter 2 inhibitors (SGLT2i). These medications constitute the four pillars of HfrEF treatment. Each class has a distinct mechanism that when used together synergistically enhances patient outcomes. In this review we discuss drug treatment options and key considerations in the management of people with chronic HFrEF. The review also highlights the importance of medication management, addressing complications and promoting lifestyle modifications.