New drugs: big changes in conservative heart failure therapy?

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  Figure 1:. Therapeutic algorithm for a patient with symptomatic heart failure with reduced ejection fraction according to the current guidelines from the European Society of Cardiology (from [3]); green indicates a class I recommendation; yellow indicates a class IIa recommendation. aSymptomatic New York Heart Association class II–IV. bHFrEF LVEF <40%. cIf ACEi not tolerated/contraindicated, use ARB. dIf MR antagonist not tolerated/contraindicated, use ARB. eWith a hospital admission for HF within the last 6 months or with elevated natriuretic peptides (BNP >250 pg/ml or NT-proBNP >500 pg/ml in men and 750 pg/ml in women). fWith an elevated plasma natriuretic peptide level (BNP ≥150 pg/ml or plasma NT-proBNP ≥600 pg/ml, or if HF hospitalization within recent 12 months, plasma BNP ≥100 pg/ml or plasma NT-proBNP ≥400 pg/ml). gIn doses equivalent to enalapril 10 mg twice daily. hWith a hospital admission for HF within the previous year. iCRT is recommended if QRS ≥130 ms and left bundle branch block (in sinus rhythm). jCRT should/may be considered if QRS ≥130 ms with non-left bundle branch block (in sinus rhythm) or for patients in atrial fibrillation provided a strategy to ensure…