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Heart Failure Pharmacotherapy

Dusty L Lisi1, Kira Gaddis2, Mahmoud H Abdou3

  • 1Department of Pharmacology, Emory St. Joseph's Hospital, Atlanta, GA, USA.

The Medical Clinics of North America
|October 24, 2025
PubMed

Insights

Pharmacotherapy for heart failure with reduced ejection fraction (HFrEF) uses four main drug classes to reduce mortality and hospitalizations. Additional medications help manage symptoms, improving patient outcomes.

Area of Science:

  • Cardiology
  • Pharmacology
  • Internal Medicine

Background:

  • Pharmacotherapy is fundamental for managing heart failure with reduced ejection fraction (HFrEF).
  • Current treatment guidelines emphasize four primary drug classes for HFrEF management.

Purpose of the Study:

  • To outline the foundational pharmacotherapy for HFrEF.
  • To discuss the role of additional diuretics in symptom management.
  • To highlight recent advancements in heart failure with preserved ejection fraction (HFpEF) treatment.

Main Methods:

  • Review of established pharmacologic principles in HFrEF.
  • Analysis of data from recent randomized clinical trials.

Main Results:

  • Four pillars of HFrEF pharmacotherapy (beta-blockers, RAAS modulators, MRAs, SGLT2 inhibitors) significantly reduce mortality and hospitalizations.
  • Loop diuretics, with potential addition of thiazide diuretics, effectively alleviate HF symptoms.
  • Recent trials have established new management strategies for HFpEF.

Conclusions:

  • The four pillars form the cornerstone of evidence-based HFrEF pharmacotherapy.
  • Symptomatic management in HF requires tailored diuretic strategies.
  • Contemporary research is reshaping the approach to HFpEF treatment.

Keywords:
Ejection fractionGDMTHeart failureHeart failure with preserved ejection fractionHeart failure with reduced ejection fraction

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