← Back to dossier
Patient handout

Heart failure with reduced EF (HFrEF, LVEF ≤40)

PRODUCTION

1. Your condition

This handout is for heart failure with reduced ef (hfref, lvef ≤40). Your care team identified this based on: echo lvef ≤40 — hfref phenotype.

Other reasons your team may use this plan: dyspnea on exertion / orthopnea / pnd; lower-extremity edema; nt-probnp elevated with reduced lvef.

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

MedicationStarting doseHowWhenWhat it does
sacubitril/valsartan24/26 mgPOBIDPARADIGM-HF (PMID 25176015) — CV death/HHF HR 0.80 (0.73–0.87), all-cause death HR 0.84 (0.76–0.93), p<0.001, stopped early at 27 mo; titrate q2–4 wk to 97/103 BID; 2022 AHA/ACC/HFSA Class I (PMID 35363499)
lisinopril2.5–5 mgPOonce dailyFoundational ACEi mortality benefit (SOLVD/CONSENSUS class); switch to ARNi when feasible — 2022 AHA/ACC/HFSA Class I (PMID 35363499)
losartan25–50 mgPOonce dailyHEAAL — high-dose 150 mg preferred when ACEi/ARNi unavailable; 2022 AHA/ACC/HFSA Class I (PMID 35363499)

Plan: GDMT 4-pillar — HFrEF (LVEF ≤40) (ACC/AHA 2022 HF; 2024 ACC ECDP HFrEF)

3. Your action plan

Use these zones to know what to do based on how you feel.

GREEN — All clear — at dry weight, baseline activity — ACC/AHA 2022
If you have:
  • Weight at or within 1 kg of dry weight — ACC/AHA 2022
  • No new dyspnea, orthopnea, PND, or edema — ACC/AHA 2022
  • Usual activity tolerance — ACC/AHA 2022
  • No new lightheadedness or palpitations — ACC/AHA 2022
Do this:
  • Take all the four foundational heart-failure medications meds as prescribed every day — ACC/AHA 2022
  • Sodium <2 g/day; fluids per plan — ACC/AHA 2022
  • Daily weight at the same time, after voiding, in same clothing — ACC/AHA 2022
  • Keep all clinic + lab appointments — ACC/AHA 2022
YELLOW — Caution — early congestion or symptom drift — ACC/AHA 2022
If you have:
  • Weight up 2 kg in 3 days OR 2.5 kg in a week — ACC/AHA 2022; STRONG-HF Mebazaa Lancet 2022
  • New ankle / leg swelling — ACC/AHA 2022
  • Need extra pillow to sleep, or waking up short of breath — ACC/AHA 2022
  • Increased fatigue or reduced exercise tolerance — ACC/AHA 2022
  • New persistent cough — ACC/AHA 2022
Do this:
  • Take prescribed rescue diuretic dose (e.g., extra furosemide 40 mg) per action plan — ACC/AHA 2022
  • Recheck weight in 24 h; recheck symptoms — ACC/AHA 2022
  • Tighten sodium and fluid intake — ACC/AHA 2022
  • Call HF clinic / PCP within 24–48 h — ACC/AHA 2022
Call your provider if:
  • Weight not back to dry-weight range after 48 h of rescue diuretic — ACC/AHA 2022
  • Any worsening symptoms despite rescue diuretic — ACC/AHA 2022
RED — Medical alert — severe decompensation — ACC/AHA 2022
If you have:
  • Severe shortness of breath at rest — ACC/AHA 2022
  • Cannot lie flat / cannot sleep due to breathlessness — ACC/AHA 2022
  • New chest pain or pressure — ACC/AHA 2022
  • Confusion, fainting, or near-fainting — ACC/AHA 2022
  • Cold/clammy skin, very low BP, or HR <50 / >130 — ACC/AHA 2022; ESC 2021
Do this:
  • Call 911 / emergency services immediately — ACC/AHA 2022
  • Sit upright; loosen tight clothing — ACC/AHA 2022
  • Do not drive yourself — call EMS — ACC/AHA 2022
  • Bring medication list + weight diary — ACC/AHA 2022
Call your provider if:
  • Any red zone symptom — go to ED now, do not wait — ACC/AHA 2022

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

  • SBP <90 + cool extremities, oliguria, AMS, or rising lactate — ACC/AHA 2022; ESC 2021(life-threatening)
  • K ≥5.5 on MRA / ACEi / ARNi — ACC/AHA 2022; RALES Pitt NEJM 1999
  • Cr rise >0.3 mg/dL or >50% from baseline on ACEi / ARNi / MRA / SGLT2i — ACC/AHA 2022

5. Follow-up

Visit cadence by NYHA + recent titration; cardiac rehab; vaccinations (flu, pneumococcal, COVID, RSV)

6. Sources

Guideline: 2022 AHA/ACC/HFSA HF Guideline (Circulation/JACC) + 2023 ESC Focused Update + 2024 ACC HFrEF Expert Consensus Decision Pathway

  1. pubmed.ncbi.nlm.nih.gov/35363499
  2. pubmed.ncbi.nlm.nih.gov/35379503
  3. pubmed.ncbi.nlm.nih.gov/38466244