Chronic heart failure with reduced ejection fraction.

Heart failure with reduced ejection fraction is a clinical syndrome of dysp­ nea, exercise intolerance and/or edema resulting from an impairment of ejec­ tion of blood, usually documented by a left ventricular ejection fraction of 40% or less on echocardiography.1,2 Cor on­ ary artery disease is a major cause; therefore, stress testing or, in the pres­ ence of angina, coronary angiography should be performed.1,2 Recommended testing includes electrocardiography, complete blood count, urinalysis, and measurement of electrolytes, creati­ nine, thyroid­stimulating hormone, glu­ cose and brain natriuretic peptide.2 Other investigations should be individ­ ually tailored, with a focus on poten­ tially reversible causes. What medications improve outcomes in patients with this condition?