Heart Failure with Reduced EF — RACP Adult Medicine MCQ

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

ModerateCardiologyHeart Failure with Reduced EFRACP Adult Medicine

A 62-year-old woman with HFrEF (LVEF 25%) is stable on enalapril, carvedilol, eplerenone, and empagliflozin. Her resting heart rate is 82 bpm in sinus rhythm. Which agent should be added next?

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

Reveal the answer and explanation

Correct answer: C — Ivabradine

Ivabradine is recommended for patients with HFrEF who remain in sinus rhythm with a heart rate ≥70 bpm despite maximally tolerated beta-blocker. The SHIFT trial demonstrated reduced heart failure hospitalisation. She is already on four-pillar therapy; ivabradine is the appropriate add-on.

Reference: NHFA/CSANZ – 2023 – Heart Failure Guidelines