Heart Failure with Reduced EF for Total Shoulder Replacement

You are reviewing the online pre-anaesthesia documents and health questionnaire of a 75-year-old man who is scheduled to have a left total shoulder replacement on your list at a private hospital in two days' time. A health summary from his general practitioner provides medical information as follows: Medical history Hypertension Hyperlipidaemia Ischaemic heart disease – two coronary stents inserted 2 years ago Heart failure with reduced ejection fraction - cardiology review six months ago - echocardiogram: LVEF 32%, mild mitral regurgitation, bi-atrial enlargement Medications Clopidogrel 75 mg once daily Bisoprolol 5 mg once daily Dapagliflozin 5 mg once daily Spironolactone 25 mg bd Atorvastatin 10 mg once daily Sacubitril/valsartan 97 mg/103 mg bd GTN sublingual spray PRN On the online health questionnaire, the man has indicated an exercise capacity of one flight of stairs. He writes that he has had worsening shortness of breath and increasing leg swelling over the past few months.