Primary prevention

Aggressive control and treatment of risk factors should be considered in order to prevent acute heart failure. Coronary artery disease is managed with aspirin, beta-blockers, statins, and ACE inhibitors.

Optimizing treatment of hypertension, smoking cessation, and lipid control provides substantial benefit in patients with coronary artery disease.

Optimal control of hypertension may require more than one antihypertensive medication.

For the general population, regular physical activity, maintenance of a normal weight, healthy dietary patterns, and avoidance of smoking are also recommended to reduce future risk of heart failure.[2]

In asymptomatic patients with reduced left ventricular ejection fraction (LVEF), ACE inhibitors are cardioprotective and reduce further decline in LVEF.[27] Beta-blockers may also be considered in this group of patients.

All patients with diabetes mellitus, in addition to metabolic control, need aggressive control of lipids, BP (target <130/80 mmHg) and should be treated with an ACE inhibitor, regardless of the level of the left ventricular (LV) dysfunction, when other cardiovascular risk factors are present.​[28]​ Patients with type 2 diabetes and either established cardiovascular disease or at high cardiovascular risk should use sodium-glucose cotransporter 2 (SGLT2) inhibitors (e.g., dapagliflozin, empagliflozin, or sotagliflozin) to prevent hospitalizations for heart failure.[2][29]​ Patients with diabetes taking SGLT2 inhibitors are at increased risk of developing diabetic ketoacidosis (including euglycemic ketoacidosis).[30]

Alcohol consumption and excessive salt and fluid intake should be discouraged in patients with known LV dysfunction.[1][2]

Drugs that can cause or potentiate heart failure should be avoided, if possible.[31]

Secondary prevention

All patients with heart failure are recommended to have pneumococcal vaccination and annual influenza vaccine.

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