MediumCardiologyHeart failure with reduced ejection fractionca-mccqe1ca-rcpsc-im
A 69-year-old woman with heart failure with reduced ejection fraction (LVEF 30%) remains symptomatic (NYHA II-III) despite being on maximally tolerated ACE inhibitor, evidence-based beta-blocker and mineralocorticoid receptor antagonist. Her eGFR is 60 mL/min/1.73 m^2 and potassium is 4.5 mmol/L. According to contemporary Canadian heart failure guidance, which additional medication class should routinely be added to optimise prognosis?