A 58-year-old man with chronic HFrEF (LVEF 30%) remains in sinus rhythm at a resting heart rate of 82 beats per minute despite maximally tolerated beta-blocker therapy, and he is already on sacubitril/valsartan and dapagliflozin. He remains NYHA class II to III. Which additional drug is indicated?
- A Amiodarone
- B Digoxin
- C Ivabradine ✓
- D Ranolazine
Correct answer: C. Ivabradine
Explanation
The SHIFT trial showed that ivabradine, a selective funny current (If) inhibitor acting on the SA node, reduces hospitalization for worsening heart failure in patients with sinus rhythm, LVEF 35% or less, and resting heart rate 70 bpm or higher despite maximal beta-blockade. Digoxin may reduce symptoms but does not improve this endpoint and is not preferred here. Amiodarone is reserved for ventricular arrhythmia control, and ranolazine treats angina.
Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.