A 68-year-old man has new breathlessness and orthopnoea. His ejection fraction is 30 percent. Which combination forms the core of long-term drug treatment for heart failure with reduced ejection fraction?
Answer and explanation
Correct answer: B. An ACE inhibitor, a beta-blocker, a mineralocorticoid receptor antagonist and an SGLT2 inhibitor
- Step 1: Heart failure with reduced ejection fraction has a prognostic drug set.
- Step 2: NICE and ESC-style guidance use an ACE inhibitor or ARNI, beta-blocker, MRA and SGLT2 inhibitor, with diuretics for congestion.
Answer
An ACE inhibitor, a beta-blocker, a mineralocorticoid receptor antagonist and an SGLT2 inhibitor.
Why not the others: A loop diuretic alone, continued indefinitely at the lowest dose to control his symptoms and fluid: Diuretics relieve congestion but do not improve survival. An NSAID and a thiazide diuretic taken on alternate days to relieve joint pain and swelling: NSAIDs worsen heart failure. A calcium channel blocker, digoxin and regular long-term aspirin for symptom and rate control: CCBs such as verapamil are harmful in HFrEF and aspirin is not part of therapy.
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