Heart failure is a progressive disease that causes substantial morbidity and mortality. It is estimated that 80.000-100.000 Norwegians have the disease, and the number is rising as the population over 75 years is increasing. Pharmacological treatment is of utmost importance as it can prevent progression of heart failure and decrease hospital admissions. In 2016 both the European Society of Cardiology and the American Heart Association renewed their guidelines for pharmacological treatment of heart failure, mainly due to recent groundbreaking advances in therapeutic drugs for heart failure with reduced ejection fraction (HFrEF). In this paper, we will explore pharmacological treatment for HFrEF in the past and present, as well as possibilities for the future.