Topic overview

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For stable, symptomatic HFrEF, selected β-blockers—carvedilol, metoprolol succinate, and bisoprolol—reduce heart rate and oxygen demand and help limit harmful sympathetic effects on cardiac remodeling. They are started at a very low dose and increased gradually; initiation is avoided during acute decompensation. The lesson also surveys RAAS-directed therapies: ACE inhibitors, ARBs for patients who cannot tolerate ACE inhibitors, sacubitril/valsartan for eligible symptomatic patients, and mineralocorticoid receptor antagonists as add-on therapy in specified groups. It highlights shared monitoring of potassium and kidney function, along with class-specific adverse effects and precautions. Together, these topics provide a framework for understanding treatment choices and safety in HFrEF.