Question

A 68-year-old man with heart failure with reduced ejection fraction (left ventricular ejection fraction 30 percent) remains symptomatic with exertional dyspnoea despite optimized doses of an angiotensin receptor-neprilysin inhibitor, a beta blocker and a mineralocorticoid receptor antagonist. His estimated glomerular filtration rate is 65 mL/min/1.73 m² and potassium 4.6 mmol/L. According to contemporary Canadian guidelines, which additional therapy should routinely be added to improve outcomes?

Accepted Answer

Add an SGLT2 inhibitor such as dapagliflozin.

Answer

Add a thiazide diuretic regularly.

Answer

Add digoxin as a routine fourth agent.

Answer

Switch back to an ACE inhibitor from the angiotensin receptor-neprilysin inhibitor.

Answer

No further disease-modifying therapy is indicated.

Practice question