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Beta blockers counter this inappropriately high sympathetic activity, eventually leading to an improved ejection fraction, despite an initial reduction in ejection fraction. [citation needed] Trials have shown beta blockers reduce the absolute risk of death by 4.5% over a 13-month period.
The RALES trial [30] showed that the addition of spironolactone can improve mortality, particularly in severe cardiomyopathy (ejection fraction less than 25%.) The related medication eplerenone was shown in the EPHESUS trial [ 31 ] to have a similar effect, and it is specifically labelled for use in decompensated heart failure complicating ...
Some evidence suggests that vasodilating beta blockers, such as nebivolol, can provide a benefit for patients with heart failure regardless of ejection fraction. [58] Additionally, because of the chronotropic perturbation and diminished LV filling seen in HFpEF the bradycardic effect of beta blockers may enable improved filling, reduce ...
An ejection fraction (EF) is the volumetric fraction (or portion of the total) of fluid (usually blood) ejected from a chamber (usually the heart) with each contraction (or heartbeat). It can refer to the cardiac atrium , [ 1 ] ventricle , [ 2 ] gall bladder, [ 3 ] or leg veins, [ 4 ] although if unspecified it usually refers to the left ...
This is defined as a left ventricular ejection fraction (LVEF) of 40% or less. About half of heart failure patients have a reduced ejection fraction. [2] Other types of heart failure are heart failure with mildly reduced ejection fraction (LVEF between 40% and 50%) and heart failure with preserved ejection fraction (LVEF 50% or higher). [1] [3]
Sacubitril/valsartan can be used instead of an ACE inhibitor or an angiotensin receptor blocker in people with heart failure and a reduced left ventricular ejection fraction (LVEF), [17] [9] alongside other standard therapies (e.g. beta-blockers) for heart failure.
Ivabradine is recommended for people with symptomatic heart failure with reduced left ventricular ejection fraction who are receiving optimized guideline-directed therapy (as above) including the maximum tolerated dose of beta-blocker, have a normal heart rhythm and continue to have a resting heart rate above 70 beats per minute. [114]
Non-dihydropyridines are contraindicated in patients with heart failure with reduced ejection fraction (HFrEF), and second- or third-degree atrioventricular block. [13] Special attention should be given to the coadministration of non-DHP with beta-blockers or ivabradine due to the increased risk of bradycardia. [13]
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