Heart Failure with Reduced Ejection Fraction — ABIM Board MCQ

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

ModerateCardiologyHeart Failure with Reduced Ejection FractionABIM Board

A 64‑year‑old patient is newly diagnosed with heart failure with reduced ejection fraction (LVEF 28%). Which of the following combinations constitutes guideline‑directed medical therapy to reduce mortality and hospitalizations?

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

Reveal the answer and explanation

Correct answer: C — ARNI or ACEI/ARB, evidence‑based beta‑blocker, MRA, and SGLT2 inhibitor

According to current 2022 ACC/AHA/HFSA guidelines, the foundational, mortality‑reducing pharmacologic regimen for HFrEF includes four classes: (1) ARNi (preferred) or ACE inhibitor/ARB, (2) evidence‑based beta‑blocker, (3) mineralocorticoid receptor antagonist (MRA), and (4) SGLT2 inhibitor. This combination (quadruple therapy) reduces mortality and hospitalizations. Distractor A (ACEi + hydralazine) is incomplete and reserved for select populations (e.g., African Americans with NYHA III–IV or ACEi intolerance); B omits MRA and SGLT2i; D lacks foundational agents and is for rate/ symptom control; E is symptomatic only and lacks disease‑modifying therapies.

Reference: 2022 ACC/AHA/HFSA Guideline for the Management of Heart Failure, 2022; ACC article “New ACC, AHA, HFSA Guideline Updates Recommendations For Managing HF” and ACC expert analysis on inpatient initiation of HFrEF therapies, https://www.acc.org/Latest-in-Cardiology/Articles/2022/06/01/12/11/Inpatient-Initiation-of-HFrEF-Therapies