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HFrEF — EECC MCQ

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EasyHeart FailureHFrEFEECC

A 58-year-old man is diagnosed with heart failure with reduced ejection fraction (LVEF 30%) following a dilated cardiomyopathy workup. He is NYHA class II with blood pressure 118/72 mmHg, heart rate 78 bpm, and eGFR 68 mL/min/1.73 m2. Which combination of medications should be initiated as foundational therapy?

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

Reveal the answer and explanation

Correct answer: A — ACE inhibitor, beta-blocker, MRA, and SGLT2 inhibitor

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

Per the 2021 ESC HF Guidelines (with 2023 Focused Update), the four pillars of foundational therapy for HFrEF are: ACEi/ARNI, beta-blocker, MRA, and SGLT2 inhibitor. All four should be initiated as soon as possible. A loop diuretic is for symptomatic congestion only and is not disease-modifying. ARNI can replace ACEi but is not first-line initial therapy (C). Ivabradine (C) is second-line. Hydralazine/ISDN (D) is reserved for ACEi/ARB/ARNI intolerance or as add-on in African-Caribbean patients.

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