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This review focuses on pharmacological treatment of chronic HF with reduced ejection fraction (HFrEF), which affects approximately 60% of patients with HF. Patient outcomes are determined by early diagnosis and individualised treatment. The cornerstone of HFrEF management consists of four key medication classes: ACE inhibitors or angiotensin receptor-neprilysin inhibitor (ARNI), beta-blockers, mineralocorticoid receptor antagonists (MRA) and sodium-glucose co-transporter 2 inhibitors (SGLT2i). These medications constitute the four pillars of HfrEF treatment. Each class has a distinct mechanism that when used together synergistically enhances patient outcomes. In this review we discuss drug treatment options and key considerations in the management of people with chronic HFrEF. The review also highlights the importance of medication management, addressing complications and promoting lifestyle modifications.<\/jats:p>","DOI":"10.1136\/dtb.2024.000050","type":"journal-article","created":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T11:45:23Z","timestamp":1756986323000},"page":"133-138","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Drug treatment of chronic heart failure with reduced ejection fraction"],"prefix":"10.1136","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4142-7882","authenticated-orcid":false,"given":"Aamir","family":"Shamsi","sequence":"first","affiliation":[{"name":"King\u2019s College Hospital NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Sado","sequence":"additional","affiliation":[{"name":"King\u2019s College Hospital NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,9,4]]},"reference":[{"key":"2025090404451001000_63.9.133.1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab368"},{"key":"2025090404451001000_63.9.133.2","unstructured":"Joint Formulary Committee . 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