Cardiology: heart failure therapy: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

General Medicine · Cardiology: heart failure therapy

Sample item

A 60-year-old man with ischaemic cardiomyopathy and an ejection fraction of 30% remains in NYHA class III despite an ACE inhibitor, a beta-blocker and a mineralocorticoid receptor antagonist at optimal doses. His HbA1c is normal. Which additional drug has been shown to reduce cardiovascular death and heart failure hospitalisation?

ADapagliflozinBPioglitazoneCDigoxinDAmlodipine

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Dapagliflozin

SGLT2 inhibitors such as dapagliflozin and empagliflozin reduce heart failure hospitalisation and cardiovascular death in heart failure with reduced ejection fraction, regardless of diabetes status. They are now one of the four foundational drug classes alongside RAAS inhibitors, beta-blockers and mineralocorticoid antagonists.

Option by option

A. Dapagliflozin (correct)
Correct. Benefit is independent of diabetes, through natriuresis and favourable haemodynamic and metabolic effects.
B. Pioglitazone
Pioglitazone causes sodium and water retention and can precipitate or worsen heart failure.
C. Digoxin
Digoxin may reduce hospitalisation and relieve symptoms but has no proven mortality benefit.
D. Amlodipine
Amlodipine is neutral for outcomes in heart failure and is not part of disease-modifying therapy.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, Dapagliflozin. SGLT2 inhibitors such as dapagliflozin and empagliflozin reduce heart failure hospitalisation and cardiovascular death in heart failure with reduced ejection fraction, regardless of diabetes status.

Why is "Pioglitazone" not the answer?

Pioglitazone causes sodium and water retention and can precipitate or worsen heart failure.

Why is "Digoxin" not the answer?

Digoxin may reduce hospitalisation and relieve symptoms but has no proven mortality benefit.

Why is "Amlodipine" not the answer?

Amlodipine is neutral for outcomes in heart failure and is not part of disease-modifying therapy.

What concept does this question test?

It tests Cardiology: heart failure therapy in General Medicine. They are now one of the four foundational drug classes alongside RAAS inhibitors, beta-blockers and mineralocorticoid antagonists.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Cardiology: heart failure therapy?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.