skip to main content

HFpEF — EECC MCQ

Instant feedback + full explanation. One question, done properly.

ModerateHeart FailureHFpEFEECC

A 74-year-old woman with heart failure and an LVEF of 52% (HFpEF) has persistent NYHA class III symptoms despite optimisation of blood pressure control and diuretic therapy. Her NT-proBNP is 1850 pg/mL. eGFR is 55 mL/min/1.73 m2. What pharmacological therapy has the strongest evidence for reducing heart failure hospitalisation in this patient?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Dapagliflozin or empagliflozin

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

Per the 2023 ESC Focused Update, SGLT2 inhibitors (dapagliflozin or empagliflozin) are the only treatment class with a Class I, Level A recommendation in HFpEF, based on EMPEROR-Preserved and DELIVER trials. Sacubitril/valsartan (A) showed borderline results in PARAGON-HF. Spironolactone (B) showed a neutral primary endpoint in TOPCAT. Vericiguat (D) is indicated for recently decompensated HFrEF. Digoxin (E) has no mortality benefit in HFpEF.

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