For heart failure with reduced ejection fraction, an angiotensin-converting enzyme (ACE) inhibitor with a beta€‘blocker licensed for heart failure is the first line recommendation. Dose should be titrated according to response, including blood pressure and serum sodium and potassium levels.9

Angiotensin receptor blockers can be used if ACE inhibitors are not tolerated. Mineralocorticoid receptor/aldosterone antagonists can be added to combined ACE inhibitor and beta-blocker therapy if necessary.

Specialist initiated treatments include ivabradine, sacubitril valsartan, hydralazine with a nitrate or amiodarone, if suitable. Digoxin may also be introduced for worsening or severe heart failure if first line treatment is insufficient.

Diuretics can relieve congestive symptoms and fluid retention. People with HFpEF should usually be offered a low to medium dose of loop diuretics (for example, less than 80mg furosemide per day).

Calcium channel blockers (verapamil, diltiazem and short-acting dihydropyridine agents) should be avoided in heart failure with reduced ejection fraction.

In addition, people with heart failure should be offered an annual flu vaccine, as well as having vaccination against pneumococcal disease (only required once).

Non-drug treatment includes pacemakers, cardiac resynchronisation therapy devices and implantable cardiovert defibrillators, or surgery.