HardCardiologyHeart failure with reduced ejection fractionau-amcau-racp
A 68-year-old man with known heart failure with reduced ejection fraction (LVEF 30%) due to ischaemic cardiomyopathy remains symptomatic with NYHA class II-III dyspnoea despite maximally tolerated ACE inhibitor, beta blocker and mineralocorticoid receptor antagonist. Blood pressure is 120/70 mmHg, potassium 4.6 mmol/L, eGFR 55 mL/min/1.73 m². What is the most appropriate additional therapy to reduce mortality and heart failure hospitalisation?