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ModerateCardiovascularHeart failure – MRA therapyuk-plab-1

A 60-year-old man presents with a 6-month history of progressive exertional dyspnoea, orthopnoea and bilateral ankle swelling. Echocardiography shows left ventricular ejection fraction of 25%. According to NICE heart failure guidance, which of the following should also be offered to reduce mortality in patients who remain symptomatic despite ACE inhibitor and beta-blocker?

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