MediumCardiologyHeart failure with reduced ejection fractionca-mccqe1ca-rcpsc-im
A 68-year-old man with ischaemic cardiomyopathy (LVEF 30%) presents for routine follow-up. He has NYHA class II symptoms. His current medications include sacubitril-valsartan at target dose, bisoprolol at target dose, spironolactone 25 mg daily, and furosemide 40 mg daily. Blood pressure is 108/70 mm Hg, heart rate 68 beats/min, creatinine 100 µmol/L, and potassium 4.6 mmol/L. According to contemporary Canadian heart failure guidance, which additional therapy has the strongest evidence for further reduction in cardiovascular death and heart failure hospitalisation?