Question

A 68-year-old man with a previous anterior myocardial infarction and reduced left ventricular ejection fraction (30%) is clinically stable on ramipril, bisoprolol, and furosemide. He has no contraindications to additional heart failure therapies. According to the latest Canadian heart failure guidelines, which change best reflects the recommended pharmacologic standard of care for heart failure with reduced ejection fraction (HFrEF)?

Accepted Answer

Switch ramipril to an angiotensin receptor-neprilysin inhibitor and add an SGLT2 inhibitor and a mineralocorticoid receptor antagonist

Answer

Add a calcium channel blocker for afterload reduction

Answer

Stop the beta blocker and increase the loop diuretic

Answer

Add digoxin as routine therapy for all patients with HFrEF

Answer

Switch all medications to short-acting formulations

Practice question