American Board of Internal Medicine (ABIM) Certification Practice Exam

The American College of Cardiology recommends replacing an ACE inhibitor with which drug in specific heart failure patients?

1. Digoxin

2. Valsartan-sacubitril

3. Amiodarone

4. Beta-blockers

The correct answer is: Valsartan-sacubitril

The recommendation to replace an ACE inhibitor with valsartan-sacubitril in specific heart failure patients stems from the evidence supporting the efficacy of this drug combination in reducing morbidity and mortality in heart failure. Valsartan-sacubitril, marketed as Entresto, is a combination of an angiotensin receptor blocker (ARB) and a neprilysin inhibitor. Neprilysin inhibition promotes vasodilation and natriuresis, which can enhance heart failure management by improving hemodynamics and reducing the burden on the heart. Clinical trials have demonstrated that valsartan-sacubitril offers superior outcomes compared to ACE inhibitors alone, including fewer hospitalizations for heart failure and a lower risk of death due to cardiovascular causes. Thus, for patients specifically indicated for this therapy and who are not tolerating ACE inhibitors, valsartan-sacubitril is considered a more effective treatment option within the established guidelines for managing heart failure. In contrast, digoxin is primarily used for rate control or to enhance contractility and does not replace ACE inhibitors in this context. Amiodarone is an antiarrhythmic drug that does not serve the same purpose as ACE inhibitors or valsartan-sacubitril in managing heart failure. Additionally, while beta-block