What are the four pillars of heart failure management?

The selection of ACE inhibitors, beta blockers, mineralocorticoids, and SGLT2 inhibitors represents the foundational approach to managing heart failure, particularly heart failure with reduced ejection fraction (HFrEF). Each component plays a specific and critical role in optimizing heart function, reducing symptoms, and improving overall outcomes for patients.

ACE inhibitors are essential as they help to reduce afterload and preload by inhibiting the renin-angiotensin-aldosterone system (RAAS), leading to vasodilation and decreased blood volume. This class of medication also has beneficial effects on cardiac remodeling.

Beta blockers are vital in heart failure management because they protect against the adverse effects of sympathetic nervous system activation, which can lead to further heart damage. They improve left ventricular function and help to reduce hospitalizations due to heart failure exacerbations.

Mineralocorticoid receptor antagonists, such as spironolactone and eplerenone, also inhibit the effects of aldosterone, preventing fluid retention and promoting potassium retention, which is critical for patients who are often at risk of hypokalemia due to other diuretics.

Lastly, SGLT2 inhibitors have emerged as a novel treatment option for heart failure. They not only improve glycemic