Medical Treatment of Heart Failure with Reduced Ejection Fraction — Aimed at Reducing Re-hospitalisations

The reduction in re-hospitalisation for heart failure is an important therapeutic goal in patients with heart failure, because of the effect of hospitalisations on well- being and prognosis. LCZ696 and ivabradine have been shown not only to reduce events in patients with HFrEF but also to reduce heart failure hospitalisations occurring both as first events, and as recurrent hospitalisations with a similar degree of efficacy. Given the neutral effect of ivabradine on blood pressure, this drug should be always considered in patients in sinus rhythm. LCZ696 has some blood pressure lowering effect that may limit its implementation in some patients. Therefore, in order to fully benefit from the prognostic benefits of these two drugs patients who are still symptomatic after the administration of an ACEi a beta- blocker and a MRA should be switched to these therapies and controlling heart rate with the combination of beta- blockers and ivabradine. Treatments should be implemented with appropriate disease management programs and fluid retention should be monitored with devices like the CardioMEMS that have been proven to effectively reduce events