LVEF ≤40% with symptoms.
Regimens
Foundation (the four pillars)
ARNI/ACEi + β-blocker + MRA + SGLT2i — start low, titrate to target
Loop diuretic
Furosemide 40 mg PO OD–BD for congestion only (not prognostic)
Examples
Sacubitril/valsartan 49/51 mg BD, bisoprolol 1.25 mg OD, spironolactone 25 mg OD, dapagliflozin 10 mg OD
Monitoring
- • BP, HR, weight daily
- • U&E, K⁺ at 1–2 weeks then 1 month
- • Echo at 3–6 months for response
Common prescribing errors
- ⚠ Stopping β-blocker during acute decompensation (reduce dose, don't stop)
- ⚠ ACEi + ARB combination
- ⚠ Diuretic monotherapy without prognostic agents
