Heart Failure

Heart failure (HF) affects nearly 7 million Americans.¹ It is one of the leading causes of hospitalization in older adults. Patients with HF have a shorter median survival after a HF hospitalization than adults of the same age without HF.¹ Treatments are recommended in patients with HF based on ejection fraction (EF).

Guideline-directed medical therapy (GDMT) can save lives.²

$SGLT-2 inhibitors can be prescribed for HF with any ejection fraction. ARNIs like sacubitril/valsartan can be used in patients with an EF < 60%, with ACE inhibitors and ARBs recommended for EF$

While effective treatments that can improve survival and decrease HF hospitalization remain under-prescribed, a small fraction of heart failure patients receive guideline-recommended medications.³

Rapid initiation of HF medications in patients with reduced EF improves outcomes

Based on the findings of the STRONG-HF randomized controlled trial, quickly starting and titrating recommended medications resulted in an absolute reduction of 8% in cardiovascular mortality and HF hospitalization in the first six months after hospitalization compared to usual care.⁴ Based on the findings, clinicians should:

Start low doses of all four classes quickly
Plan titration to achieve optimal doses

All patients with HF benefit from non-pharmacologic interventions

exercise
cardiac rehabilitation
medication adherence
potentially helpful options include: routine weighing and sodium restriction

Information current at time of publication, August 2026.

The content of this website is educational in nature and includes general recommendations only; specific medical decisions should only be made by a treating clinician based on the individual patient’s clinical condition.

References

Writing Committee Members. HF STATS 2025: Heart Failure Epidemiology and Outcomes Statistics An Updated 2025 Report from the Heart Failure Society of America. J Card Fail. 2026;32(2):439-498.
Heidenreich PA, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022;145(18):e895-e1032.
Greene SJ, et al. Contemporary Guideline-Directed Medical Therapy for Heart Failure in the United States: The EMPACE Study. J Am Heart Assoc. 2026;15(6):e044785.
Mebazaa A, et al. Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure (STRONG-HF): a multinational, open-label, randomised, trial. Lancet. 2022;400(10367):1938-1952.