MediumCardiologyHeart failure with reduced ejection fractionau-amcau-racp
A 70-year-old man with long-standing hypertension and type 2 diabetes presents with gradually worsening exertional dyspnoea and orthopnoea. On examination, he has bilateral basal crackles, pitting ankle oedema and an S3 gallop. Echocardiogram shows a left ventricular ejection fraction of 30% with global hypokinesis. He is on perindopril and a beta blocker at target doses. Blood pressure is 110/70 mmHg. According to contemporary heart failure management, which additional medication has the strongest mortality benefit and should be considered next?