skip to main content

Heart Failure (HFrEF) GDMT — ABIM Board MCQ

Instant feedback + full explanation. One question, done properly.

ModerateCardiologyHeart Failure (HFrEF) GDMTABIM Board

A 62‑year‑old man with newly diagnosed HFrEF (LVEF 30%) is being discharged following decompensation. His blood pressure and renal function are stable, allowing safe initiation of therapy. Which regimen most accurately reflects foundational guideline‑directed medical therapy for HFrEF?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Sacubitril/valsartan, evidence‑based beta‑blocker, mineralocorticoid receptor antagonist, and an SGLT2 inhibitor

Option E is the only regimen that includes all four foundational classes of HFrEF GDMT (ARNI/RAAS inhibitor, beta‑blocker, MRA, SGLT2 inhibitor). Option A omits MRA and SGLT2i. Option B inappropriately uses ivabradine and digoxin without foundational therapies. Option C (hydralazine/nitrates) is adjunctive and indicated only in African‑American patients or those intolerant to RAAS inhibitors—not foundational. Option D provides only symptomatic relief. US guidelines strongly recommend initiating all four pillars before discharge, as supported by the 2022 AHA/ACC/HFSA guideline and 2024 ACC expert consensus.

Reference: 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure; 2024 ACC Expert Consensus Decision Pathway (Heart Failure GDMT), https://professional.heart.org/en/science-news/2022-guideline-for-the-management-of-heart-failure