You are an NP in the heart failure clinic. A patient with a history of alcoholic cardiomyopathy has an ejection fraction

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You are an NP in the heart failure clinic. A patient with ahistory of alcoholic cardiomyopathy has an ejection fraction of 35%(HFrEF). They have been sober for 2 years. Recent stress test wasnegative for coronary ischemia. BP 132/83 mm Hg. EKG reveals normalsinus rhythm with a rate of 74. There is no evidence of ischemia orconduction disturbances. Medications include: Aspirin 81 mg oraldaily, carvedilol 25 mg oral twice daily, spironolactone 25 mg oraldaily, and furosemide 20 mg oral daily. They stopped takinglisinopril due to a cough. They report an allergy to disulfiram.All CBC and BMP results are within defined limits.
Questions to consider:
What medication classes are indicated in HFrEF?
What medication(s) could you prescribe instead of lisinopril aspart of goal-directed medical therapy (GDMT) for heart failure?
What education should you give the patient?
What monitoring is indicated? How often?
When would you like to see the patient in the clinic again?