Guidelines from the American College of Cardiology, American Heart Association,Heart Failure Society of America:
Classifications for heart failure or separated into four categories based on ejection fraction and disease history.
HF with reduced ejection fraction of 40% or less, HF with mildly reduced EF of 41 to 49%, HF with preserved EF 50% or greater, and HF with improved EF previously 40% or less with improvement to greater than 40%.
In patients with chronic HF with reduced EF, angiotensin receptor-neprilysin inhibitors are preferred over angiotensin – converting enzyme inhibitors and angiotensin II receptor blockers.
If angiotensin receptor nebulizing inhibitors are not feasible, ACE inhibitors are preferred over angiotensin II receptor blockers, unless there is significant cough or angioedema.
Sodium glucose cotransporters2 (SGLT2) inhibitors are included across all HF categories.
Patients with HF with improved EF should continue to receive medical therapy originally indicated for HEF with reduced EF.
Evidence-based treatment of HF with preserved EF includes blood pressure control, SGLT2 inhibitors, mineralocorticoid antagonists, angiotensin receptor blockers, and angiotensin receptor-neprilysin inhibitors.