This review will outline the management of patients with symptomatic systolic heart failure or heart failure
with reduced ejection fraction (HFrEF), i.e., those with structural heart disease and previous or current symptoms. Determination
of volume status and appropriate diuretic administration is important in heart failure management. Inhibition of
the renin-angiotensin-aldosterone and sympathetic nervous systems improves survival and decreases hospitalizations in
patients with systolic or reduced ejection fraction HF (HFrEF). Beta blockers and aldosterone antagonists improve ejection
fraction. Indications for additional agents including nitrates plus hydralazine, digoxin, statins, omega 3 polyunsaturated
fatty acids, anticoagulants, and antiarrhythmics will be discussed. Choice of agents, dose-related effects, strategies to
minimize adverse effects, and medications to avoid will be presented.
Keywords: ACE inhibitor, aldosterone antagonist, angiotensin receptor blocker, beta blocker, heart failure with reduced ejection
fraction, systolic heart failure.
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