Heart Failure with Reduced Left Ventricular Ejection Fraction (i.e. <40%)
“Systolic heart failure, or heart failure with a reduced left ventricular ejection fraction (<40%), should be managed with an ACE inhibitor and a $-blocker. If there is volume overload, a diuretic should be added. For those who cannot tolerate an ACE inhibitor, an angiotensin receptor blocker can be used. However, an ACE inhibitor should not be given with an angiotensin receptor blocker, as this combination increases mortality. Digoxin will decrease symptoms and lessen the chance of hospitalization, but mortality is not reduced. Mortality and hospitalization can be reduced by the addition of an aldosterone antagonist such as spironolactone. In African-American patients, using a combination of hydralazine and isosorbide dinitrate improves both symptoms and mortality for those with New York Heart Association class III or IV heart failure with a reduced ejection fraction.” ABFM
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