HFmrEF — EECC MCQ

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ModerateHeart FailureHFmrEFEECC

A 66-year-old woman with HFmrEF (LVEF 42%) has hypertension and atrial fibrillation. She is on bisoprolol 5 mg, candesartan 16 mg, furosemide 40 mg, and edoxaban 60 mg. She remains NYHA class II. Her NT-proBNP is 650 pg/mL. Which additional therapy has a Class I recommendation for HFmrEF?

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Correct answer: B — Dapagliflozin

Explanation lettering: C = shown as B · E = shown as C · B = shown as E

Per the 2023 ESC Focused Update, SGLT2 inhibitors (dapagliflozin or empagliflozin) have a Class I, LOE A recommendation for HFmrEF - the only drug class at this recommendation level in this population. Sacubitril/valsartan (A), MRA (D), and other HFrEF therapies have weaker (Class IIb) recommendations in HFmrEF. Ivabradine (B) is not recommended in AF. Vericiguat (E) has been studied in recently decompensated HFrEF, not HFmrEF.

Reference: ESC (2023): Focused Update of the 2021 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure