Heart failure (HF) with reduced ejection fraction (HFrEF) is becoming more prevalent as the US population ages. Although the clinical presentation of HFrEF is remarkably similar to that of HF with preserved ejection fraction (HFpEF), the primary etiology may be different. In particular, cardiac ischemia is a common cause of HFrEF and should be considered in any patient with new-onset HFrEF. Although there is some overlap in the management strategies for HFpEF and HFrEF, there are some key distinctions. It is vital to ensure that all patients with HFrEF are adhering to goal-directed management and therapy within 6 months of diagnosis to reduce morbidity and mortality. Some patients with HFrEF will benefit from device therapy with an implantable cardioverter-defibrillator and/or cardiac resynchronization therapy. Referral to a cardiology subspecialist is recommended for select patients with HFrEF.