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Management of heart failure with reduced ejection fraction in 2021: an update for GPs.

WHAT DRUGS ARE CURRENTLY IN USE FOR HEART FAILURE WITH REDUCED EJECTION FRACTION TO IMPROVE PROGNOSIS? Until recently, three groups of drugs were recommended by NICE as standard therapy to improve symptoms and prognosis in heart failure with reduced ejection fraction (HFrEF). The aspiration is for patients to receive them at the maximal tolerated doses (Table 1). The groups are: angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB) or angiotensin-neprilysin inhibitors (ARNI); beta-blockers (BB); and — for patients remaining symptomatic — mineralocorticoid receptor antagonists (MRA). In patients with persistent or worsening symptoms whose LVEF is <35%, any ACEI/ ARB should be replaced with sacubitril– valsartan (Entresto®), the current sole licensed member of ARNI, as both symptoms and prognosis are improved.2