Heart failure (HF) is a complex clinical syndrome with symptoms and signs due to
cardiac dysfunction, leading to high hospitalization and morbidity. HF treatment
has rapidly developed in recent decades, and breakthroughs have been made.
Although conventional neurohormonal blockade therapies, including
-blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin
receptor blockers (ARBs), and mineralocorticoid receptor antagonists (MRAs),
significantly improve the prognosis of patients with heart failure with
reduced ejection fraction (HFrEF), mortality and rehospitalization remain high.
Therefore, new therapies are needed. Previous studies demonstrated that
ivabradine, angiotensin receptor-neprilysin inhibitor (ARNI), sodium-glucose
cotransporter 2 (SGLT2) inhibitor, vericiguat, and omecamtiv mecarbil (OM) are
beneficial for HFrEF. However, there is a lack of systematic review of the most
optimal manner to use under various clinical conditions. This review summarizes
the current knowledge regarding these therapies to give suggestions regarding
clinical use timing, application scope, and optimal therapies under various
conditions. Most importantly, we propose the HF diamond approach to express the
necessity of conjunction of therapies. Different from the current guidelines, we
suggest to use the diamond approach in an early and comprehensive manner at the
beginning of ventricular remodeling in HFrEF to prevent further deterioration of
HF and maximize the prognosis of patients.