A 72-year-old male with chronic heart failure (ejection fraction 28%) presents with progressive orthopnea, bilateral lower extremity pitting edema, and elevated jugular venous pressure. Which drug class has been shown to reduce both cardiovascular mortality and heart failure hospitalizations across the entire spectrum of ejection fractions?

Answer and explanation

Correct answer: B. Sodium-Glucose Cotransporter 2 (SGLT2) inhibitors

  1. Step 1: Guideline-directed medical therapy (GDMT) for Heart Failure with reduced Ejection Fraction (HFrEF) includes the 'four pillars': SGLT2 inhibitors, ARNI/ACEi, beta-blockers, and mineralocorticoid receptor antagonists (MRAs).
  2. Step 2: Randomized landmark clinical trials (DAPA-HF and EMPEROR-Reduced) demonstrated that SGLT2 inhibitors significantly reduce cardiovascular death and hospitalizations.
  3. Step 3: Loop diuretics provide symptomatic decongestion but have not been shown to reduce long-term mortality.
Answer
Sodium-Glucose Cotransporter 2 (SGLT2) inhibitors.
Why not the others: 'Loop diuretics' relieve fluid overload symptoms without improving long-term survival; 'Digoxin' reduces hospitalizations without reducing mortality; 'Dihydropyridine calcium channel blockers' do not improve heart failure outcomes.

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