Traditional pharmacologic approaches to the management of patients with heart failure with reduced systolic function (HFrEF) have been based on neurohormonal inhibition on a background of hemodynamic effects. The agents that have been shown to be associated with improved outcomes in this patient population are inhibitors of the renin-angiotensin-aldosterone (RAAS) system, mineralocorticoids, and beta-blockers. More recently, two agents were FDA-approved for improved outcomes in HFrEF, sacubitril/valsartan, and ivabradine. Sacubitril/valsartan combines RAAS inhibition (valsartan) with inhibition of natriuretic peptide breakdown, while ivabradine is a novel means of heart rate control. While the evidence for clinical benefit of sacubitril/valsartan is substantial, evidence for the use of ivabradine is emerging.
