Table 15

Important Pathophysiologic Targets in HFrEF and Treatments

TargetTherapy
Renin-angiotensin-aldosterone systemACEI, ARBs, ARNI, aldosterone antagonists
Sympathetic nervous systemBeta blockers
Natriuretic and other vasodilator peptidesARNI
Elevated heart rate (in sinus rhythm, on optimal beta-blocker dose)Ivabradine, beta blocker
Balanced vasodilation and oxidative stress modulation in African AmericansHYD/ISDN
Arrhythmic sudden deathImplantable cardioverter-defibrillators
Ventricular dyssynchrony due to conduction abnormalitiesCardiac resynchronization therapy
CongestionDiuretics (with chronic ambulatory pulmonary artery pressure monitoring in select patients)
Reduced aerobic capacityExercise training/cardiac rehabilitation

ACEI = angiotensin converting enzyme inhibitors; ARB =angiotensin receptor blockers; ARNI = angiotensin receptor-neprilysin inhibitor; HYD/ISDN = hydralazine/isosorbide dinitrate.