Heart Failure — RACP Adult Medicine MCQ

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ModerateCardiologyHeart FailureRACP Adult Medicine

A 60-year-old man with known HFrEF (LVEF 25%) presents with worsening dyspnoea. His current medications are ramipril, carvedilol, and spironolactone at target doses. His heart rate is 78 bpm in sinus rhythm. Which additional medication has proven mortality benefit?

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Correct answer: A — Empagliflozin

SGLT2 inhibitors (empagliflozin – EMPEROR-Reduced trial; dapagliflozin – DAPA-HF trial) have demonstrated mortality and hospitalisation benefits in HFrEF regardless of diabetes status. They are now part of the 'four pillars' of HFrEF treatment alongside ACEi/ARB/ARNI, beta-blocker, and MRA. Ivabradine is only indicated if HR >70 bpm on maximised beta-blocker. This patient's HR is 78 bpm but empagliflozin provides the strongest incremental mortality benefit.

Reference: NHF – 2023 – Heart Failure Guidelines Update; eTG – 2025 – Cardiovascular