Figure 1. Therapeutic algorithm for HFrEF.

HFrEF = heart failure with reduced ejection fraction; ARNI = angiotensin receptor-neprilysin inhibitors; ACEI = angiotensin converting enzyme inhibitors; ARB = angiotensin receptor blocker; MRA = mineralocorticoid receptor antagonists; SGLT2 = sodium-glucose co-transporter 2; GDMT = guideline directed medical therapy; NYHA = New York Heart Association; LVEF = left ventricular ejection fraction; ICD = implantable cardioverter-defibrillator; CRT-D/P = cardiac resynchronization therapy-defibrillator/pacemaker; NSR = normal sinus rhythm; HR = heart rate; HF = heart failure; SR = sinus rhythm; AF = atrial fibrillation; LVAD = left ventricular assist device.

*If patients with chronic HFrEF are intolerant to ACEI because of cough or angioedema and when the use of ARNI is not feasible, the use of ARB is recommended to reduce morbidity and mortality.