Figure 4.

A simplified chart for treatment of HFrEF patients. All HFrEF patients should be started on beta-blockers, SGLT2i, MRAs, and ARNi (or ACEi) as soon as possible after diagnosis. Ivabradine should be considered in patients already on beta-blockers with sinus rhythm (SR) and heart rate > 70. Hydralazine and isosorbide dinitrate should be considered in self-identified black patients with LVEF < 35% despite optimal treatment and may be considered in those who cannot tolerate ACEi, ARB, or ARNi treatment. Omecamtiv mecarbil is a treatment option for patients with hypotension and low eGFR. Vericiguat may be considered in patients with NYHA class II–IV who have worsening HF and low eGFR despite optimal treatment.