A 64-year-old female with a history of long-standing hypertension presents with dyspnea on minimal exertion and bilateral ankle edema. Echocardiography reveals a left ventricular ejection fraction of 32%. Which of the following pharmacological agents has been shown to reduce all-cause mortality in patients with heart failure with reduced ejection fraction (HFrEF)?

Answer and explanation

Correct answer: D. Bisoprolol

  1. Step 1: Identify the pathology: The patient has chronic heart failure with reduced ejection fraction (HFrEF, LVEF < 40%).
  2. Step 2: Guideline-directed medical therapy (GDMT) with evidence of mortality reduction includes beta-blockers (bisoprolol, carvedilol, sustained-release metoprolol), ACEi/ARNI, mineralocorticoid receptor antagonists (spironolactone), and SGLT2 inhibitors.
Answer
Bisoprolol.
Why not the others: 'Furosemide' provides symptomatic relief of volume overload but does not reduce long-term mortality; 'Digoxin' reduces hospitalizations without altering overall mortality; 'Amlodipine' is a dihydropyridine calcium channel blocker that has neutral mortality effects in HFrEF.

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