HFrEF: Guideline Directed Medical Therapy "Must Be On" • ACEI, ARB, or ARNI AND select Beta Blockers (bisoprolol, carvedilol, metoprolol XL) "Can Be On" • Diuretics* • Aldosterone antagonist • Hydralazine + Isosorbide dinitrate** • Ivabradine • Digoxin Optimize BB to target dose first before increasing ACEI or ARB dose for higher mortality benefit. Mortality Reducing: • ACEI or ARB • ARNI • Select BBs • Aldosterone antagonist • Hydralazine + Isosorbide dinitrate** Morbidity Reducing: • Diuretics* • Ivabradine • Digoxin *Loop diuretics preferred (add metolazone in diuretic resistance) **For African American patients #hfref #management #medications #chf #cardiology #GDMT
