What is considered the cornerstone of therapy for HFrEF?

The cornerstone of therapy for Heart Failure with reduced Ejection Fraction (HFrEF) is a combination of ACE inhibitors (ACEI), beta-blockers (BB), and aldosterone antagonists. ACE inhibitors are essential for their ability to block the renin-angiotensin-aldosterone system (RAAS), which is often overactive in heart failure, leading to vasoconstriction and fluid retention. By inhibiting this system, ACE inhibitors help reduce afterload and preload, improve myocardial oxygen demand, and ultimately enhance left ventricular function.

Beta-blockers play a prominent role in managing HFrEF by reducing heart rate, improving left ventricular function, and decreasing mortality rates. They serve to counteract the excessive sympathetic stimulation that is prevalent in heart failure, providing cardiac protection and improving exercise tolerance.

Aldosterone antagonists, such as spironolactone or eplerenone, add an additional benefit by blocking the action of aldosterone, which contributes to fluid retention and myocardial fibrosis. Their use has been shown to further decrease morbidity and mortality in patients with HFrEF.

This combination therapy is widely supported by clinical guidelines and evidence-based practice, making it the foundational approach in treating patients with HFrEF. Other options listed do not