Heart Failure – HFrEF Management & ARNI Therapy

A 58-year-old man with a 10-year history of hypertension and type 2 diabetes mellitus presents with progressive dyspnea, orthopnea, and lower limb edema for 3 months. His BP is 142/88 mmHg, HR 102/min, JVP 8 cm, and bilateral crackles are heard on auscultation. Echocardiography shows LVEF 32%, dilated LV cavity (LVEDV 180 mL), and restrictive mitral inflow pattern (E/A ratio 2.2, DT 140 ms). He is already on lisinopril 10 mg daily, metoprolol 50 mg twice daily, and furosemide 40 mg daily. Which of the following is the MOST appropriate next step in management?