Recommendation 44: We recommend against the routine use of calcium channel blockers in patients with HFrEF (Strong Recommendation, Moderate Quality Evidence).

Value and preferences: Several RCTs have demonstrated no benefits on, or worsening of, HF outcomes in patients treated with CCB. Diltiazem, verapamil, nifedipine and felodipine should be avoided. Amlodipine may be considered for other indications such as persistent hypertension or angina symptoms despite use of guideline-directed medical therapy (GDMT).

• Amlodipine causes dose-related peripheral edema and should be considered when assessing peripheral edema potentially related to HF.