HardCardiovascularHeart failure with reduced ejection fractionuk-plab-1
A 62-year-old man on Warfarin for atrial fibrillation presents with increasing shortness of breath on exertion. Echocardiography shows a left ventricular ejection fraction of 32% with global hypokinesia. He has ankle oedema and orthopnoea. He is already on maximum tolerated Ramipril and Bisoprolol. According to NICE guidance, what is the next pharmacological therapy to consider?