Heart failure (HF) is a growing global public health problem affecting at least 26 million people worldwide. The evidence-based landscape for HF treatment has changed at a rapid rate over the last 30 years. International guidelines for the management of HF now recommend the use of four pillars in all patients with reduced ejection fraction: angiotensin receptor neprilysin inhibitors or ACE inhibitors, beta blockers, mineralocorticoid receptor antagonists and sodium-glucose co-transporter-2 inhibitors. Beyond the main four pillar therapies, numerous further pharmacological treatments are also available in specific patient subtypes. These armouries of drug therapy are impressive, but where does this leave us with individualised and patient-centred care? This paper reviews the common considerations needed to provide a holistic, tailored and individual approach to drug therapy in a patient with HF with reduced ejection fraction, including shared decision making, initiating and sequencing of HF pharmacotherapy, drug-related considerations, polypharmacy and adherence.
- heart failure
- medication adherence
- quality of health care
- heart failure, systolic
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Contributors PF, JBe and JBa planned the manuscript equally. PF authored the first draft. JBe and JBa contributed to the content and edited the manuscript and tables.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests PF declares previous honoraria for scientific advice, lecture fees and/or educational grants from AstraZeneca, Novartis, Pharmacosmos, Servier, Novartis and Vifor. JBe declares previous honoraria for scientific advice, lecture fees and/or educational grants from AstraZeneca, Boehringer Ingelheim, Lilly, Novartis, Pharmacosmos, Servier, Novartis and Vifor. JBa declares previous honoraria for scientific advice, lecture fees and/or educational grants from Novartis, Boehringer Ingelheim, AstraZeneca, Vifor and Servier.
Provenance and peer review Commissioned; internally peer reviewed.
Author note References which include a * are considered to be key references.