Heart failure with reduced ejection fraction therapy moves beyond four-pillar standard
Vericiguat addition, mechanism-targeted programs, and emerging genetically-defined HFrEF approaches are reshaping the post-four-pillar landscape.
Heart failure with reduced ejection fraction (HFrEF) has been four-pillar therapy (ARNI, beta-blocker, MRA, SGLT2) since 2021. Vericiguat (sGC stimulator) added a fifth class in selected high-risk populations. Cardiac myosin activators in HFrEF, gene therapy programs for inherited cardiomyopathy, and additional mechanism-targeted programs are in late-stage trials. The genetic-cardiomyopathy testing infrastructure is a structural commercial enabler.
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- SnapshotHFrEF therapy reference (2026)