What is the first-line therapy to add for a patient with Stage 3 heart failure having preserved left ventricular ejection fraction?

In managing a patient with Stage 3 heart failure and preserved left ventricular ejection fraction (HFpEF), the first-line therapy is typically a diuretic. Diuretics are essential in treating heart failure, as they help manage fluid overload, which is a common symptom in these patients. By promoting the excretion of sodium and water, diuretics alleviate symptoms such as edema and dyspnea, improving the patient's quality of life.

In this context, the need to control fluid retention and its associated complications is paramount, especially as symptoms can severely impact function and well-being. Diuretics also play a role in improving exercise tolerance and reducing hospitalizations due to heart failure exacerbations.

The other options, although useful in different contexts, do not primarily address the immediate symptoms and needs of a patient with heart failure and preserved ejection fraction in the same way that diuretics do. Statins are mainly used for cholesterol management, alpha blockers are not standard in this scenario, and digitalis is typically used in heart failure with reduced ejection fraction or for rate control in atrial fibrillation, not as a first-line agent for HFpEF. Thus, diuretics stand out as the most appropriate and effective initial treatment in this situation