Heart Failure Fact or Fiction: Management of HFrEF

A 57-year-old woman with known ischemic cardiomyopathy, heart failure with reduced ejection fraction (HFrEF), and left ventricular ejection fraction (LVEF) 25% is seen in the heart failure (HF) clinic. She has no acute concerns.

Her blood pressure is 110/60 mm Hg, heart rate is 72 bpm, oxygen saturation is 97% on room air, and jugular venous pressure is 8 cm H2O. There is a regular rate and rhythm. There is no edema. Laboratory studies performed in the clinic show potassium level 3.7 mmol/L, serum creatinine level 0.9 mg/dL with estimated glomerular filtration rate 75 mL/min/1.73m2, and N-terminal pro–B-type natriuretic peptide (NT-proBNP) level 601 pg/mL. She is currently on sacubitril/valsartan 49/51 mg BID, carvedilol 25 mg BID, spironolactone 25 mg daily, and furosemide 20 mg daily.

She feels well overall and is hesitant to start new medications.

The patient is "stable" and guideline-directed medical therapy should not be escalated at present.

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