Table 1.

Recommendations of 2021 HF guidelines about treatment with HF drugs for patients with symptomatic HFrEF

Drugs	Class of recommendation/level of evidence
An ACE‐I is recommended to reduce the risk of HF hospitalization and death	IA
A beta‐blocker is recommended to reduce the risk of HF hospitalization and death	IA
An MRA is recommended to reduce the risk of HF hospitalization and death	IA
Dapagliflozin or empagliflozin is recommended to reduce the risk of HF hospitalization and death	IA
Sacubitril/valsartan is recommended as a replacement for an ACE‐I to reduce the risk of HF hospitalization and death	IB
An ARB is recommended to reduce the risk of HF hospitalization and CV death in patients unable to tolerate an ACE‐I or sacubitril–valsartan	IB
Ivabradine should be considered in patients in sinus rhythm and a resting heart rate ≥ 70 b.p.m. despite treatment with a beta‐blocker* to reduce the risk of HF hospitalization and CV death	IIaB
*Unable to tolerate or have contraindications for a beta‐blocker	*IIaC
Vericiguat may be considered in patients who have had worsening HF to reduce the risk of CV mortality or HF hospitalization	IIbB

ACE‐I, angiotensin‐converting enzyme inhibitor; ARB, angiotensin II receptor blocker; CV, cardiovascular; HF, heart failure; HFrEF, heart failure with reduced ejection fraction; MRA, mineralocorticoid receptor antagonist.

Source: Table performed with data from reference 7.