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Heart failure with reduced ejection fraction — CCFP MCQ

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HardChronic disease managementHeart failure with reduced ejection fractionCCFP

A 67-year-old with symptomatic HFrEF takes maximally tolerated sacubitril-valsartan, carvedilol and spironolactone. He is euvolemic, eGFR is 54 mL/min/1.73 m² and he does not have diabetes. Which addition provides further disease-modifying benefit?

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

Reveal the answer and explanation

Correct answer: B — Add an SGLT2 inhibitor with renal monitoring

Explanation lettering: D = shown as A · A = shown as B · B = shown as D

A is correct. An SGLT2 inhibitor completes the four foundational HFrEF drug classes and improves heart-failure outcomes even without diabetes. B may worsen systolic failure. C removes an evidence-based beta-blocker and overstates digoxin benefit. D adds diuresis without congestion and risks electrolyte injury. E discards foundational renin-angiotensin-neprilysin therapy. Blood pressure, renal function, volume status and sick-day counselling should accompany initiation.

Reference: Canadian Cardiovascular Society: 2021 heart failure—reduced EF guideline: https://ccs.ca/guideline/2021-heart-failure-reduced-ef/