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Overview of the therapy of heart failure with reduced ejection fraction

Wilson S Colucci, MD
Section Editor
Stephen S Gottlieb, MD
Deputy Editor
Susan B Yeon, MD, JD, FACC


Heart failure (HF) is a common clinical syndrome resulting from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood. HF may be caused by disease of the myocardium, pericardium, endocardium, heart valves, vessels, or by metabolic disorders [1]. HF due to left ventricular dysfunction is categorized according to left ventricular ejection fraction (LVEF) into HF with reduced ejection fraction (with LVEF ≤40 percent, known as HFrEF; also referred to as systolic HF) and HF with preserved ejection fraction (with LVEF>40 percent; known as HFpEF; also referred to as diastolic HF).

An overview of the management of chronic HFrEF will be presented here [1,2]. The management of acute HF, drugs that should be avoided or used with caution in patients with HF, the management of refractory HF, and therapy of HFpEF (diastolic HF) are discussed separately. (See "Drugs that should be avoided or used with caution in patients with heart failure" and "Management of refractory heart failure with reduced ejection fraction" and "Treatment and prognosis of heart failure with preserved ejection fraction" and "Treatment of acute decompensated heart failure: General considerations" and "Treatment of acute decompensated heart failure: Components of therapy".)


Goals of therapy — The goals of therapy of heart failure with reduced ejection fraction (HFrEF) are to reduce morbidity (ie, reducing symptoms, improving health-related quality of life and functional status, decreasing the rate of hospitalization), and to reduce mortality.

Major society guidelines — Several major societies and organizations have published guidelines for the treatment of HF [1-4]. These include the 2013 American College of Cardiology Foundation/American Heart Association guideline [1], the Canadian Cardiovascular Society guidelines [4], the 2012 European Society of Cardiology guidelines [2], the 2010 Heart Failure Society of America guidelines [3], and the 2010 National Institute for Health and Care Excellence chronic HF guideline [5].

With few exceptions, these societies make similar recommendations regarding the treatment of HFrEF. Our approach is in broad agreement with these guidelines.


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Literature review current through: Feb 2017. | This topic last updated: Tue Feb 16 00:00:00 GMT+00:00 2016.
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