6th March 2024

A 50-year-old man with gout, hypercholesterolemia and heart failure with reduced ejection fraction attends his heart failure review and reports worsening shortness of breath during routine activities such as showering.

A 50-year-old man with gout, hypercholesterolemia and heart failure with reduced ejection fraction attends his heart failure review and reports worsening shortness of breath during routine activities such as showering. He is taking sacubitril/valsartan 97/103mg BD, bisoprolol 10mg OD and spironolactone 25mg OD. His LVEF is 32% on his most recent echocardiogram performed one week ago. His ECG in the clinic shows sinus rhythm with a heart rate of 77 and QRS duration of 120ms. What is the next appropriate step in his management?

Select the SINGLE most appropriate option from the list below. Select ONE option only.