MediumCardiologyHeart failure with reduced ejection fractionca-mccqe1ca-rcpsc-im
A 63-year-old man with ischaemic cardiomyopathy (left ventricular ejection fraction 30 percent) presents to clinic with exertional dyspnoea NYHA class II and mild ankle oedema. He is on maximally tolerated bisoprolol, ramipril, and spironolactone. Blood pressure is 112/68 mm Hg, heart rate 68 beats per minute. According to contemporary CCS heart failure guidelines, which additional agent should be prioritised to further reduce heart failure hospitalisation and cardiovascular mortality?