A 62-year-old man with newly diagnosed HFrEF (LVEF 28%), NYHA class II symptoms, mild ankle oedema, and an eGFR of 65 mL/min/1.73 m² presents after di...

Question

A 62-year-old man with newly diagnosed HFrEF (LVEF 28%), NYHA class II symptoms, mild ankle oedema, and an eGFR of 65 mL/min/1.73 m² presents after discharge for volume overload. Blood pressure is 122/74 mm Hg. Which outpatient regimen best reflects guideline-directed medical therapy to reduce mortality/hospitalisation?

Accepted Answer

Start sacubitril/valsartan, an evidence-based beta-blocker, spironolactone, and an SGLT2 inhibitor as tolerated; use loop diuretic PRN for congestion

Answer

Start lisinopril and titrate before adding other agents

Answer

Start carvedilol and furosemide; defer RAAS inhibition until euvolaemia

Answer

Start ivabradine now, then consider RAAS inhibition

Answer

Use hydralazine/isosorbide dinitrate as first-line in all patients regardless of race or intolerance

us-abim MCQ (SBA): HFrEF