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ModerateCardiologyHeart failure with reduced ejection fractionus-abimus-usmle-step-2us-usmle-step-3

A 67-year-old man with a history of reduced ejection fraction heart failure (LVEF 30 percent) presents for routine follow-up. He is euvolemic and on maximally tolerated doses of sacubitril-valsartan, metoprolol succinate, and spironolactone. His eGFR is 55 mL/min/1.73 m2 and potassium is 4.4 mEq/L. Which additional medication class should be added to optimize guideline-directed medical therapy?

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