Heart Failure with Reduced Ejection Fraction: From Mechanisms to Winning Team of Management

Heart failure is a global public health and clinical problem affecting 1-2% of the adult population and course with high mortality despite of significant advances in disease modifying in past few decades. Heart failure with reduced Ejection Fraction (HFrEF) is a progressive clinical state with presence of typical symptoms of heart failure and characterized by high mortality with recurrent hospitalizations. In HFrEF evidence-based management strategies are available based on positive results of large clinical trials outcomes. Recent clinical investigations and consensus statements have generated increased clinical interest to the evidence based treatment strategies. These strategies include renin-angiotensin-aldosterone system inhibitors, beta-adrenergic blockers, mineralocorticoid receptor antagonists and sodium-glucose cotransporter 2 inhibitors. In addition, nonpharmacological approaches such as implantable cardiac defibrillators, cardiac resynchronization therapy, moderate physical activity and several other new treatment approaches have been shown to decrease mortality in selected subpopulation of patients with HFrEF. Despite of proven guideline directed medical treatment in HFrEF, significant proportion of patients remain undertreated due to not proven medication and not appropriate combination management, suboptimal dose adjustment, high comorbidity burden. In this review we discuss the proven evidence based efficacy of each pharmacologic and device therapy option in HFrEF as well as novel therapeutic strategies. On the basis of existed evidence the outcome directed effective treatment, improve of outpatient monitoring, escape of vulnerable phases of disease and target of comorbidities should be the aim of management and care on HF patients in everyday practice.