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Heart failure with reduced ejection fraction — USMLE Step 3 MCQ

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HardInternal Medicine (chronic management)Heart failure with reduced ejection fractionUSMLE Step 3

A 71-year-old man with ischemic cardiomyopathy comes for medication review. Left ventricular ejection fraction is 30%. He takes sacubitril-valsartan, metoprolol succinate, spironolactone, and furosemide. Blood pressure is 116/70 mm Hg, potassium is 4.4 mEq/L, and estimated GFR is 58 mL/min/1.73 m2. He has no diabetes. Which of the following would you recommend at the follow-up visit?

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

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Correct answer: B — Add dapagliflozin

SGLT2 inhibitors are part of guideline-directed medical therapy for symptomatic HFrEF and reduce heart failure hospitalizations and cardiovascular mortality regardless of diabetes status.

Reference: ACC/AHA cardiovascular prevention and heart failure guidance