The cornerstone for pharmacological treatment to reduce morbidity and mortality in patients with heart failure (HF) with a reduced ejection fraction (HFrEF) entails several key classes of medications, including angiotensin-converting enzyme (ACE) inhibitors, beta-blockers (BB), and mineralocorticoid receptor antagonists if the ejection fraction (EF) is ≤35 %. This evidence concerns the gene ACE and hydrops fetalis.