HardCardiologyHeart failure with reduced ejection fractionau-racpau-amc
A 65-year-old man with ischaemic cardiomyopathy (left ventricular ejection fraction 30%) remains symptomatic with NYHA class II-III dyspnoea despite maximally tolerated ACE inhibitor and beta blocker therapy. His blood pressure is 115/70 mmHg, eGFR 60 mL/min/1.73 m² and serum potassium 4.7 mmol/L. What is the MOST appropriate addition to optimise his guideline-directed medical therapy?