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Summary
Initial management of heart failure with reduced ejection fraction?
First-line treatment rests on four pharmacological pillars [1]: ACEi or sacubitril-valsartan, beta-blockers, mineralocorticoid receptor antagonists and SGLT2 inhibitors [2].

Simultaneous initiation and up-titration to target doses are recommended from the time of diagnosis [3].
Original sources
ESC 2023 – Heart Failure Guidelines
Section 5.3.1 – Pharmacological management of HFrEF, p. 42-48
GRADE A
NICE NG106 – 2018, updated 2023
1.4 Managing heart failure – First-line treatment
GRADE A
HAS 2024 – Heart Failure Pathway Guide
Chapter 3 – Initial HFrEF treatment, p. 28-35
GRADE B
Reference sources
WHONICEHASCDCESCAHAIDSAPAHOECDC
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WHONICEHAS CDCESCAHA IDSAPAHOECDC SIGNUSPSTFADA ASCOAAFPNCCN EULARESMOKDIGO GOLDGINAEAU FIGOACGATS + 25 more

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