A 72-year-old female with a history of hypertension, heart failure with reduced…

A 72-year-old female with a history of hypertension, heart failure with reduced ejection fraction (HFrEF), atrial fibrillation, and moderate COPD presents for follow-up. Her current medications include: Sacubitril/valsartan 49/51 mg BID Metoprolol succinate 100 mg daily Furosemide 40 mg daily Apixaban 5 mg BID Tiotropium inhaler daily Albuterol inhaler PRN Despite adherence to therapy, she reports increasing dyspnea with exertion and two COPD exacerbations requiring oral corticosteroids within the past year. Her blood pressure is 118/72 mmHg, heart rate is 82 bpm, SpO₂ is 92% on room air, and her most recent eGFR is 55 mL/min/1.73 m². Discussion Questions Based on current evidence-based guidelines, what pharmacotherapeutic changes would you recommend to optimize management of both HFrEF and COPD? Would an SGLT2 inhibitor be appropriate for this patient? Discuss its mechanism of action, benefits, risks, and monitoring parameters?