Question

A 60-year-old man with known heart failure with reduced ejection fraction (LVEF 30 percent) is stable on Ramipril, Bisoprolol and Frusemide. He remains symptomatic with NYHA class III breathlessness despite optimal doses. His blood pressure is 115/70 mmHg and potassium is 4.5 mmol per litre. What is the next step in optimising his heart failure therapy according to NICE?

Accepted Answer

Add Eplerenone or another mineralocorticoid receptor antagonist

Answer

Add an angiotensin receptor–neprilysin inhibitor instead of ACE inhibitor

Answer

Increase the dose of Frusemide further

Answer

Stop beta blocker and increase ACE inhibitor dose

Answer

Add long-term Amiodarone for arrhythmia prophylaxis

Practice question