A 58-year-old woman with heart failure with preserved ejection fraction (HFpEF, LVEF 55%) and NYHA class II symptoms is on furosemide and amlodipine. Blood pressure is 142/88 mmHg. The EMPEROR-Preserved trial demonstrated reduction in heart failure hospitalizations with empagliflozin in HFpEF. According to current guidelines, which additional therapy is indicated specifically to reduce HF hospitalizations in this patient?

• A Spironolactone 25 mg daily
• B Dapagliflozin 10 mg daily ✓
• C Sacubitril/valsartan
• D Carvedilol 12.5 mg twice daily

Explanation

The EMPEROR-Preserved and DELIVER trials established SGLT2 inhibitors (empagliflozin and dapagliflozin) as the first class to reduce HF hospitalizations across the full EF spectrum, including HFpEF. Spironolactone showed modest benefit in TOPCAT for reducing HF hospitalizations in HFpEF but did not meet the primary composite endpoint. Sacubitril/valsartan showed benefit in PARAGON-HF only in EF below median, not definitively in overt HFpEF. Beta-blockers are not specifically indicated for HFpEF without another indication.

Reference: Braunwald's Heart Disease, 12th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.