Korean J Intern Med.  2023 Sep;38(5):595-606. 10.3904/kjim.2023.223.

Optimization of guideline-directed medical treatment for heart failure patients with reduced ejection fraction

• Bak M
• Choi JO

• KMID: 2545686
• DOI: http://doi.org/10.3904/kjim.2023.223

Abstract

With the increasing number of medications demonstrating mortality benefits in heart failure with reduced ejection fraction (HFrEF), the pharmacological treatment of HFrEF is entering a new phase. To enhance outcomes in heart failure patients through medical treatment, the choice of appropriate medications and simultaneous and rapid uptitration are critical. However, there are several challenges encountered during this medication uptitration, including issues like hypotension, fatigue, worsening renal function, and hyperkalemia. This paper addresses strategies for effectively managing these challenges to successfully reach the maximum tolerated dose in patients. Additionally, it will discuss the management of comorbidities often associated with heart failure, the importance of exercise and rehabilitation, and the significance of proper nutrition intake, in addition to guideline-directed medical therapy.

Keyword

Heart failure, reduced ejection fraction; Cardiovascular disease; Guideline-directed medical therapy; Up-titration; Target dose