MediumCardiologyHeart failure with reduced ejection fractionca-mccqe1ca-rcpsc-im
A 68-year-old man with ischaemic cardiomyopathy (LVEF 30%) has NYHA class II symptoms despite guideline doses of ramipril and bisoprolol. He previously developed persistent serum potassium 5.8 mmol/L on spironolactone, which had to be stopped. His estimated GFR is 45 mL/min/1.73 m², and he does not have diabetes. Which additional medication class is now most appropriate to reduce heart failure hospitalisation and mortality?