HFrEF additional GDMT use criteria

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Last updated 8:10 PM on 10/9/26
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4 Terms

1
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Hydralazine/isosorbide dinitrate

Recommended if all of the following:

  • African American

  • NYHA class III-IV

  • Optimized “core 4” medications (ARNi/ACEi/ARB, beta-blocker, SGLT2i, MRA) already

OR

Recommended IF:

  • Unable to tolerate ARNi/ACEi/ARB (any race)


2
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Ivabradine

Reasonable if all of the following

  • NYHA class II-III (NOT IV)

  • EF ≤35%

  • Beta-blocker at target/max-tolerated dose already

  • Normal sinus rhythm (no afib)

  • Resting heart rate ≥70 bpm


3
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Vericiguat

May be reasonable to add if all of the following:

  • High-risk HFrEF

    • BNP >300 at baseline

    • or

    • NT-pro-BNP >1000, at baseline

  • Worsening HFrEF

    • HFrEF hospitalization within 6 months

    • or

    • On outpatient IV diuretics

  • On optimized GDMT already


4
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Digoxin

May be reasonable to add if one of the following

  • Symptomatic

  • Unable to tolerate other GDMT