Heart Failure (HFrEF) — EECC MCQ

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ModerateCardiologyHeart Failure (HFrEF)EECC

A 68-year-old with HFrEF (EF 32%), K 4.8 mEq/L, eGFR 42, on ARNI and beta-blocker. Which additional therapy is indicated if no contraindication?

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Correct answer: A — Add spironolactone

Mineralocorticoid receptor antagonists (MRAs) such as spironolactone or eplerenone reduce mortality and hospitalisation in HFrEF when eGFR >30 and K <5.0. Non-dihydropyridine calcium channel blockers (CCBs) and NSAIDs can worsen heart failure. Replacing ARNI with ACEI is a step down in therapy. Hydralazine alone lacks proven benefit in this context.

Reference: NICE NG106: Chronic heart failure in adults—diagnosis and management: https://www.nice.org.uk/guidance/ng106/chapter/recommendations