American Board of Internal Medicine (ABIM) Certification Practice Exam

Which medication class is indicated to decrease mortality in heart failure with reduced ejection fraction (HFrEF)?

1. Aldosterone antagonists

2. Statins

3. Calcium channel blockers

4. Diuretics

The correct answer is: Aldosterone antagonists

Aldosterone antagonists, such as spironolactone and eplerenone, are indicated to decrease mortality in patients with heart failure with reduced ejection fraction (HFrEF). This class of medication works by blocking the effects of aldosterone, which is a hormone that can cause sodium retention, potassium loss, and fibrosis in the heart and blood vessels. By inhibiting aldosterone's actions, these medications help reduce fluid overload, lower blood pressure, and improve cardiac remodeling, all of which are critical in managing HFrEF. Clinical trials have consistently shown that the use of aldosterone antagonists leads to a significant reduction in all-cause mortality and hospitalizations among patients with HFrEF. Their use is recommended in conjunction with other heart failure therapies such as ACE inhibitors or angiotensin receptor blockers (ARBs) and beta-blockers, which also have mortality benefits. In contrast, while statins may offer some benefit in terms of cardiovascular risk reduction in certain patient populations, they do not have a direct role in decreasing mortality specifically in heart failure with reduced ejection fraction. Calcium channel blockers are typically avoided in this context as they do not address the underlying mechanisms of heart failure related to reduced ejection fraction and may even worsen outcomes