American Board of Internal Medicine (ABIM) Certification Practice Exam

In which patient population is isosorbide dinitrate + hydralazine recommended for heart failure treatment?

1. All patients in NYHA class III and IV

2. Black patients with heart failure and reduced ejection fraction

3. Patients with preserved ejection fraction

4. Only elderly patients with heart failure

The correct answer is: Black patients with heart failure and reduced ejection fraction

The combination of isosorbide dinitrate and hydralazine is specifically recommended for Black patients with heart failure and reduced ejection fraction due to the compelling evidence from clinical trials demonstrating its efficacy in this population. This recommendation stems from studies, most notably the A-HeFT trial, which showed that this combination therapy significantly improves outcomes, including morbidity and mortality, in Black patients with symptomatic heart failure, regardless of the severity of the condition. This unique recommendation addresses the disparities in heart failure management and response to treatment based on racial and ethnic backgrounds. While isosorbide dinitrate and hydralazine can be beneficial for heart failure patients, the guideline emphasis on its use for Black patients highlights the importance of tailoring treatments to specific populations for optimal outcomes. Other patient populations mentioned do not have the same level of explicit recommendation for this combination therapy based on the existing evidence, affirming the necessity for individualized treatment approaches in heart failure management.