MediumCardiologyHeart failure with reduced ejection fractionau-amcau-racp
A 70-year-old woman with an ejection fraction of 30% following an anterior myocardial infarction 12 months ago is reviewed in a heart failure clinic. She is New York Heart Association (NYHA) class II and currently takes perindopril, bisoprolol and spironolactone at target doses. Her blood pressure is 118/70 mmHg and eGFR 70 mL/min/1.73 m². According to contemporary heart failure management recommendations, which additional medication class has the strongest evidence for further reducing cardiovascular mortality and heart failure hospitalisation in this scenario?