MRCP2-0080

MRCP2-0080

A 75-year-old man presents to the clinic with a history of long-standing heart failure with reduced ejection fraction (32%). He has been admitted multiple times this year due to heart failure decompensation and is seeking further treatment options. Upon reviewing his ECG, you note that he is in sinus rhythm with a heart rate of 64/min and has a QRS of 136 msec with left bundle branch block. His blood pressure is 98/55 mmHg, and his blood work shows:

– Hb: 130 g/L (Male: 135-180, Female: 115-160)
– Platelets: 335 * 109/L (150-400)
– WBC: 6.8 * 109/L (4.0-11.0)
– Na+: 136 mmol/L (135-145)
– K+: 4.7 mmol/L (3.5-5.0)
– Urea: 6.8 mmol/L (2.0-7.0)
– Creatinine: 126 µmol/L (55-120)

The patient is currently taking carvedilol 25 mg BD, enalapril 10 mg BD, bumetanide 2 mg BD, aspirin 75 mg, and ivabradine 2.5 mg BD. What changes to his management plan could potentially reduce his likelihood of readmission?