1. Which of the following statements is/are correct regarding the general presentation of heart failure (HF) in women, compared with men?
A. women tend to present with more symptoms of HF
B. survival rates are lower in women with HF
C. women tend to develop HF at a younger age versus men
D. all of the above
E. Unsure
2. Which subtype of HF (based on left ventricular ejection fraction; LVEF) is seen more commonly in women versus men?
A. HF with reduced ejection fraction (HFrEF)
B. HF with mid-range ejection fraction (HFmrEF)
C. HF with preserved ejection fraction (HFpEF)
D. No distinction has been noted between men and women regarding prevalence of HF subtypes
E. Unsure
3. Of the ACC/AHA heart failure stages, which is equivalent to which New York Heart Association (NYHA) Class I?
A. Stage A, High risk but no structural disorder
B. Stage B, Structural disorder, never developed symptoms
C. Stage C, Structural disorder and past or current symptoms
D. There is no ACC/AHA Stage that aligns with Class I
E. Unsure
4. Differences in treatment recommendations for women with HF as recommended by ACC/AHA 2017 updated guidelines include:
A. Increased diuretic dose is recommended for women over age 80 with HF
B. Angiotensin receptor blocker (ARB) is preferred over angiotensin converting enzyme inhibitor (ACEi) in women with HF
C. Angiotensin receptor/neprilysin inhibitor (ARNI) is more likely to be effective in women
D. Guideline recommendations for medication therapy do not differ between men and women with HF
E. Unsure
5. Which of the following categories of drugs do not act to inhibit the renin-angiotensin-aldosterone system (RAAS)?
A. Beta blocker
B. Mineralocorticoid receptor antagonist (MRA)
C. Angiotensin receptor-neprilysin inhibitor (ARNI)
D. All of these categories inhibit the RAAS
E. Unsure
6. A 76-year-old woman with moderate heart failure has just been admitted to the hospital. She is on 100 mg of metoprolol succinate once daily, losartan, and a statin. The beta blocker:
A. Should be titrated down or discontinued while she is in the hospital
B. Should not be combined with the ARB
C. Should not be discontinued abruptly due to risk of sympathetic rebound
D. Should be increased to the maximum dose of 200 mg
E. Unsure
7. Your patient, B.E., is a 71-year-old Caucasian woman with HF with reduced LV function (LVEF 32%) is currently taking an ACE inhibitor, a beta blocker, and a mineralocorticoid receptor antagonist (MRA) at recommended doses. She reports she is short of breath when she is walking her dog in the morning. Which one of the following would be the best option to optimize therapy in this patient?
A. Consider replacing her ACEi with an ARB
B. Consider replacing her ACEi with ARNI
C. Consider adding ivabradine to the regimen
D. Consider adding hydralazine/isosorbide dinitrate
E. Unsure
8. Following a myocardial infarction 6 months ago, patient M.M. has a LVEF of 32% but is asymptomatic. She would be classified as:
A. NYHA Class III, ACC/AHA Stage D
B. NYHA Class II, ACC/AHA Stage A
C. NYHA Class I, ACC/AHA Stage B
D. NYHA Class IV, ACC/AHA Stage C
E. Unsure
9. The ACC/AHA recommended therapeutic regimen for patients with preserved left ventricular function (HFpEF) is:
A. Diuretic for fluid overload
B. Consider use of ACEi, ARB or MRA
C. Consider use of beta blocker
D. All of the above
E. Unsure
10. C.J., a 69-year-old female African-American patient with heart failure (LVEF 33%), is in the pharmacy for a medication therapy review to verify that she is receiving target doses of her heart failure medications. She is taking all of the following. Which of the medication dose(s) is/are incorrect?
A. Enalapril, 20 mg twice daily
B. Carvedilol, 12.5 mg once daily
C. Spironolactone, 25 mg once daily
D. All doses are within target range for this patient
E. Unsure
Evaluation Questions
11. How confident are you in your decision about treatment for your 76-year-old patient in the question above?
A. Not at all confident
B. Somewhat confident
C. Confident
D. Highly confident
12. How confident are you in your decision about treatment for BE in the question above?
A. Not at all confident
B. Somewhat confident
C. Confident
D. Highly confident
13. How confident are you in your decision about treatment for CJ in the question above?
A. Not at all confident
B. Somewhat confident
C. Confident
D. Highly confident