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MediumMRAs (e.g. spironolactone) reduce mortality in HFrEF and are part of GDMT when K and renal function permit. Amlodipine does not improve survival; non-DHP CCBs are avoided; loop diuretics relieve congestion but do not confer survival benefit; hydralazine alone is insufficient.AHA/ACC/HFSA Guideline (2022): Management of Heart Failurecardiology

A 61-year-old woman with HFrEF (EF 28%) on metoprolol succinate and lisinopril is euvolemic, K 4.6, eGFR 62. Which addition improves survival and should be part of GDMT?

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