The prevalence of heart failure has been steadily increasing during the past few years, with a further increase predicted in the years to come. Without treatment, the syndrome of heart failure has a very poor prognosis. Advances in drug treatments and the consequent implementation of a guideline-recommended drug therapy have significantly improved the prognosis in heart failure with reduced ejection fraction (HFrEF). Besides angiotensin-converting enzyme (ACE) inhibitors (ACEi) or angiotensin receptor blockers, beta-blockers and diuretics treatment with mineralocorticoid receptor antagonists and ivabradine have become standard in the therapy of symptomatic patients with HFrEF. Recently, the impact of the adequate dosage of ACEi and beta-blockers was emphasized again. Angiotensin receptor-neprilysin inhibition is an auspicious new therapeutic approach and is predicted to play a crucial role in heart failure treatment in the coming years. The role of cardiac glycosides in the modern era of heart failure therapy is the focus of a current randomized controlled trial. Last but not least, potassium binders such as the new substance patiromer might help in overcoming the problem of hyperkalemia, which frequently limits the dosing of vital heart failure drugs. These advances offer optimism for further improvements in the prognosis and quality of life of HFrEF patients.