Which pharmacologic agents are used for treating heart failure with reduced ejection fraction (HFrEF)?

Heart failure with reduced ejection fraction (HFrEF) is a condition characterized by the heart's inability to pump blood effectively due to weakened contraction. The management of HFrEF involves the use of specific pharmacologic agents known for their effectiveness in improving symptoms, reducing hospitalizations, and increasing survival rates.

The use of ACE inhibitors (ACE-I), angiotensin II receptor blockers (ARBs), and beta-blockers is foundational in the treatment of HFrEF. ACE inhibitors work by blocking the conversion of angiotensin I to angiotensin II, leading to vasodilation, reduced afterload, and decreased preload, which ultimately improve cardiac output and reduce heart failure symptoms. ARBs provide similar benefits but are typically used for patients who cannot tolerate ACE inhibitors. Beta-blockers help reduce heart rate, lower blood pressure, and decrease the myocardial oxygen demand, which is particularly beneficial in HFrEF patients.

Diuretics, while important for symptomatic relief regarding fluid overload, do not directly improve the heart's pumping ability nor do they influence mortality. Calcium channel blockers generally are not recommended in HFrEF due to their negative inotropic effects, which can worsen heart failure symptoms. Statins are used for cholesterol management and have limited evidence in heart