A 70-year-old man came to a pharmacy with a prescription of the following medications:

• Frusemide 40 mg B.D.
• Lisinopril 20 mg daily
• Spironolactone 25 mg daily
• Carvedilol 6.25 mg B.D.

The question doesn't state what stage of HF he has, but just for teaching purposes I wanted to cover the drugs recommended for HF stage C HFrEF.

If he is stable on his current ACE inhibitor, would recommend he be switched to sacubitril/valsartan - there needs to be a gap of at least 36 hours between stopping ACEi and starting ARNi to avoid risk of angioedema.

ARNi and BB should be titrated up to the maximal tolerated dose.

In addition SGLT2 inhibitor should be added. SGLT2 inhibitors were originally used in glucose control in diabetes, dapagliflozin is currently the only SGLT2 inhibitor also licensed for HF.