Digoxin

  • May be considered in patients in sinus rhythm with an EF ≤45% who are unable to tolerate a beta-blocker (ivabradine is an alternative in patients with a heart rate ≥70 bpm). Patients should also receive an ACEI (or ARB) and an MRA (or ARB) (Class IIb; Level B recommendation)
  • May be considered in patients with an EF ≤45% and persisting symptoms (NYHA Class II–IV) despite treatment with a beta-blocker, ACEI (or ARB), and an MRA (or ARB) (Class IIb; Level B recommendation)

Hydralazine and Isosorbide Dinitrate

  • May be considered as an alternative to an ACEI or ARB, if neither is tolerated, in patients with an EF ≤45% and dilated LV (or EF ≤35%). Patients should also receive a beta-blocker and an MRA (Class IIb; Level B recommendation)
  • May be considered in patients with an EF ≤45% and dilated LV (or EF ≤35%) and persisting symptoms (NYHA Class II–IV) despite treatment with a beta-blocker, ACEI (or ARB), and an MRA (or ARB) (Class IIb; Level B recommendation)

Omega-3 Polyunsaturated Fatty Acids

  • May be considered in patients treated with an ACE (or ARB), beta-blocker, and an MRA (or ARB) (Class IIb; Level B recommendation)

TREATMENT RECOMMENDATIONS FOR HEART FAILURE WITH “PRESERVED” EJECTION FRACTION (HF-PEF)


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  • Diuretics are used to control sodium and water retention and to relieve breathlessness and edema, however, no treatment has been shown to reduce morbidity and mortality
  • Rate-limiting calcium channel blockers may be useful for ventricular rate control in patients with atrial fibrillation and the treatment of hypertension and myocardial ischemia
  • Beta-blockers may be used for ventricular rate control in patients with atrial fibrillation

REFERENCE

European Society of Cardiology. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. Available at: http://www.escardio.org/guidelines-surveys/esc-guidelines/GuidelinesDocuments/Guidelines-Acute%20and%20Chronic-HF-FT.pdf. Accessed on May 29, 2012.