For heart failure with reduced ejection fraction, which medication class is commonly prescribed at discharge to improve outcomes?

• A. Digoxin
• B. ACE inhibitors
• C. Nitrates
• D. Calcium channel blockers

Answer: (B)

In heart failure with reduced ejection fraction, the goal is to counteract the harmful activation of the neurohormonal systems that drive disease progression. ACE inhibitors do this by blocking the renin-angiotensin-aldosterone system, which lowers afterload, reduces remodeling of the heart, and decreases mortality and hospitalizations. Because of these strong survival benefits, starting an ACE inhibitor during the hospital stay and continuing it after discharge is a standard approach for improving long-term outcomes in most patients with HFrEF.

Digoxin mainly helps with symptoms and rate control but does not reliably improve survival. Nitrates aren’t routinely used to improve outcomes in all HFrEF patients, and calcium channel blockers, except in specific cases, can reduce contractility and worsen heart failure, so they’re not the general choice for improving outcomes. This is why ACE inhibitors are the commonly prescribed class at discharge to improve outcomes.