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Heart failure with preserved ejection fraction — ABIM Board MCQ

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HardCardiovascularHeart failure with preserved ejection fractionABIM Board

A 72-year-old with HFpEF, diabetes and CKD remains congested despite an appropriate loop-diuretic dose. LVEF is 61%, eGFR 38 mL/min/1.73 m2, potassium 4.6 mEq/L and blood pressure 132/76 mm Hg. Which addition most directly reduces heart-failure events?

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Correct answer: D — Add empagliflozin while continuing titrated loop-diuretic therapy

The best answer is “Add empagliflozin while continuing titrated loop-diuretic therapy”. SGLT2 inhibition reduces heart-failure hospitalization in HFpEF and is appropriate at this kidney function. Loop diuretics remain necessary for congestion, but digoxin and ivabradine lack comparable HFpEF outcome benefit. Verapamil may worsen edema, and glucocorticoids promote sodium retention and metabolic harm.

Reference: 2022 AHA/ACC/HFSA Heart Failure Guideline: https://professional.heart.org/en/science-news/2022-guideline-for-the-management-of-heart-failure