brand logo
  1. In patients presenting with dyspnea, use measurement of natriuretic peptide biomarkers to support or exclude a diagnosis of heart failure (HF).

  2. For patients with HF with preserved ejection fraction (HFpEF), initially prescribe a diuretic to manage symptoms of volume overload and an antihypertensive drug (ie, beta blocker, angiotensin-converting enzyme [ACE] inhibitor, angiotensin receptor blocker [ARB]) if hypertension is present.

  3. For patients with stage C HF with reduced ejection fraction (HFrEF), initially prescribe a low-dose ACE inhibitor, ARB, or angiotensin receptor–neprilysin inhibitor (ARNI) (ie, sacubitril-valsartan), but an ARNI is preferred. For all patients with HFrEF, prescribe an evidence-based beta blocker (ie, bisoprolol, carvedilol, extended-release metoprolol succinate). Patients can be started on an ACE inhibitor, ARB, or ARNI and beta blocker therapy simultaneously or sequentially.

  4. For patients with New York Heart Association (NYHA) class II or III HFrEF who are taking an ACE inhibitor or ARB, recommend discontinuation of the current drug and prescribe an ARNI.

  5. Use the “I Need Help” mnemonic (see Table 6) to aid in timely referral of patients with HF to a cardiology subspecialist.


  1. Strength of Evidence: SORT A

    Source: Circulation, reference 2

  2. Website:

  3. Strength of Evidence: SORT B

    Source: Circulation, reference 2

  4. Website:

  5. Strength of Evidence: SORT A

    Sources: Circulation, Circulation, J Am Coll Cardiol, references 1, 2, 30

  6. Websites:;;

  7. Strength of Evidence: SORT A

    Source: Circulation, reference 2

  8. Website:

  9. Strength of Evidence: SORT A

    Sources: J Heart Lung Transplant, JAMA, references 57 and 8

  10. Websites:;

Already a subscriber?  Log In


From $335
  • Immediate, unlimited access to all FP Essentials content
  • 60 CME credits/year
  • AAFP app access
  • Print delivery available

Edition Access

  • Immediate, unlimited access to this edition's content
  • 5 CME credits
  • AAFP app access
  • Print delivery available
Interested in AAFP membership? Learn more  Learn More

Continue Reading

Copyright © 2021 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions for copyright questions and/or permission requests.