Which drug class is included in guideline-directed medical therapy for HFrEF?

• A. Calcium channel blockers
• B. Dihydropyridine blockers
• C. SGLT2 inhibitors
• D. Statins

Answer: (C)

SGLT2 inhibitors are now a standard part of guideline-directed medical therapy for heart failure with reduced ejection fraction because large trials showed they reduce heart failure hospitalizations and cardiovascular death, even in people without diabetes. Medications in this class—empagliflozin and dapagliflozin are the most studied—improve outcomes beyond glucose control by promoting diuresis and natriuresis, lowering preload and afterload, protecting renal function, and potentially improving myocardial energy use and reducing inflammation and fibrosis. Because of these benefits, guidelines recommend adding an SGLT2 inhibitor to GDMT for nearly all patients with HFrEF who can tolerate it, regardless of diabetes status.

Calcium channel blockers, including dihydropyridine types, are not part of HF disease-modifying therapy for HFrEF because they do not improve survival and can worsen symptoms or block adequate pump function; they’re used cautiously and for other conditions like hypertension where appropriate, but they aren’t a core HF-modifying drug. Statins are important for preventing atherosclerotic events when indicated, but they do not specifically modify the course of HFrEF, so they aren’t considered a heart-failure–specific cornerstone of GDMT.