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CME: Present and novel approaches to treating heart failure with reduced ejection fraction (HFrEF): Where to start and next-line strategies


Activity Description / Statement of Need:

In this online, self-learning activity:

Heart failure (HF) is a clinical syndrome arising from diminished ventricular filling or ejection of blood. HF with reduced ejection fraction (HFrEF) is characterized by abnormality in the systolic function and a left ventricular ejection fraction (LVEF) of <40%. The prevalence of HF is about 40 million people globally and approximately 6.5 million in the U.S., and as the global population continues to age, the prevalence of HF is expected to continue increasing over the coming decades. HFrEF constitutes a major public health concern, with five-year survival rates as low as 25%, and it carries with it a significant risk of emergency department visits and hospitalizations.

There has been increased focus recently on guideline-directed medical therapy (GDMT) in HFrEF, and evidence suggests that each ten percent improvement in measures of guideline-recommended composite care is associated with a thirteen percent lower odds of 24-month mortality. Nonetheless, research shows that substantial portions of patients are not treated with guideline-recommended doses, even after taking into account dose-limiting physiological parameters, and that guideline non-adherent practice is associated with poorer outcomes.

Target Audience:

The following HCPs: Cardiologists and PCPs; physician assistants, nurse practitioners, and pharmacists who practice in cardiology; and any other HCPs with an interest in or who clinically encounter patients with HFrEF.

Commercial Support Disclosure: This program is supported by an educational grant from Merck.

This activity is free of charge.

Release Date: May 06, 2022 -- Expiration Date: May 06, 2024

Faculty: Michelle Kittleson , MD, PhD


Faculty introduction, disclosures

HFrEF introductory content

  • Epidemiology
  • Pathophysiologic principles: Cardiac contractility, compensatory mechanisms, and therapeutic targets
  • Burden of HFrEF on patients and the healthcare system

Treatment of HF

  • Present pharmacotherapy, clinical trial findings, and guideline updates
    • Initial and next-line therapies, comorbidity considerations
    • More recent and investigational therapies
      • ARNIs
      • Sinoatrial node modulation
      • SGLT2is
      • Soluble guanylate cyclase (sGC) stimulation
      • Cardiac myosin activation
      • Phosphodiesterase 1 inhibition
    • Real world evidence and ways in which its experience differs from clinical trials
    • Precision medicine in HFrEF

·       Practical considerations in therapeutic optimization

o   Individualizing treatment

o   Medication adherence and barriers to attaining target dose

o   Difficult cases: Treatment-refractory outpatients

o   Facilitating referral to a specialist

o   Palliative care

·       Patient case(s)

Summary, conclusions, and best practice recap

Learning Objectives

By the end of the session the participant will be able to:

  • Describe the pathophysiology of HFrEF such that it might inform treatment mechanisms.
  • Summarize the burden of HFrEF on patients and the healthcare system and barriers to optimal management.
  • Recall the mechanisms and place in therapy of present and emerging therapies for HFrEF.
  • Discuss the impact of recent and emerging HFrEF treatments on clinical outcomes, functional measures, and health-related quality of life.
  • Formulate a treatment plan for a patient with HF.


ACCME Activity #202290046


Faculty Disclosure and Resolution of COI

As a provider of continuing medical education, it is the policy of ScientiaCME to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. In accordance with this policy, faculty and educational planners must disclose any significant relationships with commercial interests whose products or devices may be mentioned in faculty presentations, and any relationships with the commercial supporter of the activity. The intent of this disclosure is to provide the intended audience with information on which they can make their own judgments. Additionally, in the event a conflict of interest (COI) does exist, it is the policy of ScientiaCME to ensure that the COI is resolved in order to ensure the integrity of the CME activity. For this CME activity, any COI has been resolved thru content review by ScientiaCME.

Faculty Disclosure:

Michelle M. Kittleson MD, PhD, Professor of Medicine, Smidt Heart Institute, Cedars-Sinai, has no relevant financial disclosures.

Disclosures of Educational Planners: Charles Turck, PharmD, BCPS, BCCCP, President of ScientiaCME, has no relevant financial disclosures.

Faculty will not discuss off-label uses.

All relevant financial relationships have been mitigated.

ScientiaCME adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Education. Any individuals in a position to control the content of a CE activity, including faculty, planners, reviewers or others are required to disclose all relevant financial relationships with ineligible entities (commercial interests). All relevant conflicts of interest have been mitigated prior to the commencement of the activity.

Commercial Support Disclosure: This program is supported by an educational grant from Merck.


  • Read the learning objectives above
  • Take the Pre-Test (optional). Completion of the pre-test will help us evaluate the knowledge gained by participating in this CME activity.
  • View the online activity. You may view this is in more than one session, and may pause or repeat any portion of the presentation if you need to.
  • Minimum participation threshold: Take the post-test. A score of 70% or higher is required to pass and proceed to the activity evaluation.
  • Complete the activity evaluation and CME registration. A CE certificate will be emailed to you immediately.

Cultural/Linguistic Competence & Health Disparities

System Requirements

Windows 7 or above
Internet Explorer 8
*Adobe Acrobat Reader
Mac OS 10.2.8
Safari or Chrome or Firefox
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Internet Explorer is not supported on the Macintosh

*Required to view Printable PDF Version

Perform Pre-Test (optional)

Please take a few minutes to participate in the optional pre-test. It will help us measure the knowledge gained by participating in this activity.

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