Heart Failure with Reduced EF — RACP Adult Medicine MCQ

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ModerateCardiologyHeart Failure with Reduced EFRACP Adult Medicine

A 70-year-old man with HFrEF (LVEF 30%) and NYHA class III symptoms is on ramipril, bisoprolol, and furosemide. His eGFR is 45 mL/min/1.73m² and potassium is 4.8 mmol/L. Which additional agent has the strongest mortality benefit?

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Correct answer: D — Dapagliflozin

SGLT2 inhibitors (dapagliflozin, empagliflozin) are now recommended as part of four-pillar HFrEF therapy alongside ACEi/ARB/ARNI, beta-blocker, and MRA. The DAPA-HF and EMPEROR-Reduced trials demonstrated mortality and hospitalisation benefits irrespective of diabetes status. Given the elevated potassium limiting MRA initiation, an SGLT2i is the most appropriate next agent.

Reference: NHFA/CSANZ – 2023 – Heart Failure Guidelines; CSANZ 2022 Consensus Statement