The mainstay medications for heart failure with reduced ejection fraction (HFrEF) that are known to help improve ejection fraction include: beta blockers (BB), angiotensin converting enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARB), and mineralocorticoid receptor antagonists (MRA).
These medications work through different mechanisms to help the heart pump more effectively, leading to an increase in ejection fraction, which is the percentage of blood pumped out of the heart with each beat.
How These Medications Help
Beta Blockers (BB)
- Mechanism: Beta blockers slow the heart rate and reduce the force of heart muscle contraction, which over time allows the heart to work more efficiently and reduces stress.
- Impact on Ejection Fraction: By improving the heart's efficiency and allowing it to rest more fully between beats, beta blockers can help to improve ejection fraction.
Angiotensin Converting Enzyme Inhibitors (ACEi) / Angiotensin Receptor Blockers (ARB)
- Mechanism: These medications relax blood vessels, which makes it easier for the heart to pump blood forward. They also reduce the harmful effects of certain hormones on the heart. ACEi and ARBs operate through similar mechanisms, with ARBs being used when ACEi are not tolerated.
- Impact on Ejection Fraction: By reducing the workload on the heart and improving the heart's environment, these drugs help the heart contract more effectively, thus enhancing ejection fraction.
Mineralocorticoid Receptor Antagonists (MRA)
- Mechanism: These medications block aldosterone, a hormone that can cause the body to retain salt and water, leading to harmful effects on the heart.
- Impact on Ejection Fraction: By reducing fluid retention and decreasing inflammation, MRAs can help improve heart function and lead to an increase in ejection fraction.
Table Summary of Medications
| Medication Class | Mechanism of Action | Impact on Ejection Fraction |
|---|---|---|
| Beta Blockers (BB) | Slow heart rate, reduce contraction force, promote efficiency | Improves function through efficiency and rest periods |
| ACE Inhibitors (ACEi) / ARBs | Relax blood vessels, reduce hormonal stress on the heart | Reduces workload, improves contraction |
| Mineralocorticoid Receptor Antagonists (MRA) | Block aldosterone, reduce fluid retention | Improves heart function by reducing fluid and inflammation |
It's crucial to remember that these medications are often used in combination and are part of a comprehensive management strategy for heart failure. The exact choice and dosage of medications will depend on individual patient characteristics and the recommendations of a healthcare provider.
