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MediumCardiologyHeart failure with reduced ejection fractionau-amcau-racp

A 72-year-old man with ischaemic cardiomyopathy (left ventricular ejection fraction 30%) has persistent exertional dyspnoea (NYHA class II-III) despite optimal doses of perindopril and bisoprolol. He is euvolaemic, blood pressure is 110/70 mmHg, potassium 4.5 mmol/L and eGFR 55 mL/min/1.73 m². Which additional medication is most appropriate to improve survival?

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