Alcoholic cardiomyopathy

You are an nursing practitioner in the heart failure clinic. A patient with a history of alcoholic cardiomyopathy has an ejection fraction of 35%  Heart failure with reduced ejection fraction (HFrEF). They have been sober for 2 years. Recent stress test was negative for coronary ischemia. BP 132/83 mm Hg. EKG reveals normal sinus rhythm with a rate of 74. There is no evidence of ischemia or conduction disturbances. Medications include: Aspirin 81 mg oral daily, carvedilol 25 mg oral twice daily, spironolactone 25 mg oral daily, and furosemide 20 mg oral daily. They stopped taking lisinopril due to a cough. They report an allergy to disulfiram. All complete blood count and basic metabolic panel results are within defined limits.

Questions to consider:

1. What medication classes are indicated in Heart failure with reduced ejection fraction (HFrEF)?
2. What medication(s) could you prescribe instead of lisinopril as part of goal-directed medical therapy (GDMT) for heart failure?
3. What education should you give the patient?
4. What monitoring is indicated? How often?
5. When would you like to see the patient in the clinic again?