Ivabradine and digoxin are useful in selected patients. Other treatments include Hydralazine-isosorbide dinitrate, fish oil and iron infusions.
Ivabradine may be considered for patients with HFREF, with a recent hospital admission and who are in sinus rhythm with a heart rate >70 bpm despite receiving optimal beta-blocker therapy. Ivabradine decreases heart rate by inhibiting the sinus node
Ivabradine reduces cardiovascular mortality and HF hospitalisations in patients with symptomatic HFREF, who had a recent hospital admission and were in sinus rhythm with a heart rate >70 bpm
Digoxin may be considered in patients with ongoing symptoms of HF in combination with standard drug therapy (i.e., ACE inhibitor, beta-blocker and diuretic therapy). Digoxin is often prescribed to control ventricular rate in patients with co-existing AF
Hydralazine-isosorbide dinitrate combination should be considered in patients who are actually intolerant of ACE inhibitors and ARBs or for whom these agents are contraindicated
Fish oil in combination with standard drug therapy (i.e., ACE inhibitor, beta-blocker and diuretic therapy) has been found to be useful in patients with ongoing symptoms of HF
Iron supplementation for iron deficiency