Which medications reduce mortality in heart failure with reduced ejection fraction?

Heart failure with reduced left ventricular ejection fraction may contribute to about half of cases of heart failure. Rest of them may have heart failure with preserved ejection fraction or some with mid range ejection fraction between 40 and 50%. There are several medications which have been shown to reduce mortality in heart failure with reduced ejection fraction while there are only a few in the case of heart failure with preserved ejection fraction. Though digoxin and diuretics give symptomatic relief, they may not reduce mortality in heart failure with reduced ejection fraction.

Important medications which can reduce mortality are beta blockers, angiotensin converting enzyme inhibitors, angiotensin receptor blockers and spironolactone. Among beta blockers, lipid soluble beta blockers like carvedilol and metoprolol are considered, rather than water soluble beta-blockers like atenolol. Bisoprolol which is both lipophilic and hydrophilic, with hepatic and renal excretion, is also considered in heart failure. Angiotensin Receptor-Neprilysin Inhibitor (ARNI), and combination of hydralazine and nitrate are other options. Latter combination is useful when ACE inhibitors are not tolerated. SGLT2 inhibitors are the latest addition to the list.