Cardiac device therapy has changed the landscape of heart failure management in the past decade in patients with heart failure and reduced left ventricular ejection fraction (HFREF). This has shifted some of the focus away from pharmacotherapy. This review will highlight the importance and clinical benefit of first ‘optimising’ medical therapy by introducing new, proven medications, as opposed to accepting the standard pharmacological therapy, and then analyse how treatment regimens can be further refined after device insertion. Finally, we will discuss how pharmacotherapy may be used as an avenue to reduce the proportion of patients that do not respond to device therapy.

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