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A 65-year-old female with a history of hypertension and chronic heart failure presents with worsening dyspnea on exertion, orthopnea, and bilateral lower extremity edema. On examination, jugular venous pressure is elevated and bilateral lung basilar crackles are heard. Echocardiography shows a left ventricular ejection fraction (LVEF) of 32%. Which combination of disease-modifying pharmacotherapies has been demonstrated to reduce mortality in heart failure with reduced ejection fraction (HFrEF)?

ARNI (or ACE inhibitor/ARB), beta-blocker (e.g., carvedilol), mineralocorticoid receptor antagonist (spironolactone), and SGLT2 inhibitor Loop diuretic (furosemide), digoxin, and calcium channel blocker (amlodipine) Hydralazine monotherapy, thiazide diuretic (hydrochlorothiazide), and oral potassium chloride supplements Aspirin, clopidogrel, warfarin, and high-dose verapamil

Correct Answer:

ARNI (or ACE inhibitor/ARB), beta-blocker (e.g., carvedilol), mineralocorticoid receptor antagonist (spironolactone), and SGLT2 inhibitor

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