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HFpEF Treatment — RACP Adult Medicine MCQ

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ModerateCardiologyHFpEF TreatmentRACP Adult Medicine

A 55-year-old woman with HFpEF and obesity (BMI 42) has persistent dyspnoea despite diuretics. LVEF is 55%. She has no AF. HbA1c is 44 mmol/mol (not diabetic). NT-proBNP is 320 pg/mL. She has tried exercise but is limited by dyspnoea. What is the most appropriate additional pharmacotherapy?

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Reveal the answer and explanation

Correct answer: E — HFpEF

This is HFpEF — and among options, the clinical question is about pharmacotherapy. The answer is: SGLT2 inhibitor (empagliflozin or dapagliflozin) — DELIVER and EMPEROR-Preserved trials showed benefit in HFpEF regardless of diabetes status. GLP-1 RA (semaglutide) specifically targets obesity-HFpEF (STEP-HFpEF: improved symptoms, exercise capacity, and quality of life). Both are now recommended. [Note: option set limitation]

Reference: NHFA/CSANZ – 2023 – HFpEF; DELIVER; STEP-HFpEF