Heart failure with reduced ejection fraction (GDMT)
What the major U.S. guidelines recommend, with a link to verify each at the source. A quick-reference summary for clinicians, not medical advice.
ACC/AHA/HFSA · 2022
HFrEF (LVEF <=40%): start all four pillars. ARNI (sacubitril-valsartan) preferred over ACEi/ARB, Class 1 (LOE B-R); use ACEi (Class 1, LOE A) or ARB (Class 1, LOE A) if ARNI not feasible. Beta-blocker (carvedilol, metoprolol succinate, or bisoprolol), Class 1, LOE A. MRA (spironolactone or eplerenone) if eGFR >30 and K+ <5.0, Class 1, LOE A. SGLT2i (dapagliflozin or empagliflozin) regardless of diabetes, Class 1, LOE A. Titrate to target or max tolerated doses.
Verify at ACC/AHA/HFSA →