Evidence-based, best practice for managing HF with reduced ejection fraction (HFrEF) includes pharmacotherapy; angiotensin converting enzyme (ACE) inhibitors/ angiotensin receptor blocker (ARB), beta-blockers, mineralocorticoid receptor antagonists (MRAs), angiotensin receptor-neprilysin inhibitor (ARNI), hydralazine, nitrates and omega 3 polyunsaturated fatty acids. This evidence concerns the gene ACE and hydrops fetalis.