100+ Free ABIM Advanced HF Practice Questions

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Question 1

Score: 0/0

According to the 2022 AHA/ACC/HFSA Heart Failure Guideline, which LVEF range defines HFrEF (heart failure with reduced ejection fraction)?

LVEF <=30%

LVEF <=40%

LVEF 41-49%

LVEF >=50%

to track

2026 Statistics

Key Facts: ABIM Advanced HF Exam

~$2,990

ABIM HFTC Exam Fee

ABIM 2026

~220 MCQs

Exam Length

4 modules, ~10 hr day

12 months

HFTC Fellowship

ACGME-accredited

Every 2 years

Exam Frequency

Biennial cycle

85-95%

First-Time Pass Rate

ABIM historical

4 pillars

HFrEF GDMT

2022 AHA/ACC/HFSA

HFTC is one of the newest and most procedurally oriented ABIM cardiology subspecialties, with roughly 75-90 ACGME fellowship slots per year feeding ~175 advanced HF/transplant programs and ~3,500-4,000 US heart transplants annually. The exam emphasizes the 2022 AHA/ACC/HFSA Guideline (four-pillar GDMT: ARNI, BB, MRA, SGLT2i regardless of EF), HFpEF (SGLT2i now class I), TOPCAT/DELIVER/EMPEROR/PARAGON data, tafamidis for ATTR-CM, LVAD management (HeartMate 3, pump thrombosis, GI bleeding from AVMs, aortic insufficiency), and cardiac transplant immunosuppression (tacrolimus + MMF + steroid taper, ISHLT 1R/2R/3R rejection grading, pAMR, AlloMap and donor-derived cfDNA surveillance). Board-certified advanced HF/transplant cardiologists earn a ~10-20% premium over general cardiologists with median compensation often exceeding $500K-$700K in academic and high-volume tertiary settings.

Sample ABIM Advanced HF Practice Questions

Try these sample questions to test your ABIM Advanced HF exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1According to the 2022 AHA/ACC/HFSA Heart Failure Guideline, which LVEF range defines HFrEF (heart failure with reduced ejection fraction)?

A.LVEF <=30%

B.LVEF <=40%

C.LVEF 41-49%

D.LVEF >=50%

Explanation: The 2022 AHA/ACC/HFSA guideline defines HFrEF as LVEF <=40%, HFmrEF (mildly reduced) as 41-49%, HFimpEF (improved) as baseline <=40% and now >40%, and HFpEF as >=50%. These thresholds determine which GDMT is strongly indicated.

2A patient with dyspnea and LVEF 45% on echocardiogram meets which 2022 HF guideline category?

A.HFrEF

B.HFmrEF

C.HFpEF

D.Stage A HF

Explanation: LVEF 41-49% defines HFmrEF (mildly reduced ejection fraction). Patients in this group benefit from many HFrEF therapies — ARNI, BB, MRA, and SGLT2i all have class 2a or better recommendations — reflecting increasing evidence these patients respond to HFrEF-type GDMT.

3A patient with hypertension and diabetes but no structural heart disease or HF symptoms is classified as which ACC/AHA HF stage?

A.Stage A (at risk for HF)

B.Stage B (pre-HF)

C.Stage C (symptomatic HF)

D.Stage D (advanced HF)

Explanation: ACC/AHA stage A is 'at risk for HF' — patients with HF risk factors (HTN, DM, obesity, CAD, cardiotoxic exposures) but without structural heart disease or HF symptoms. Stage B is structural disease without symptoms, C is symptomatic HF, D is advanced/refractory HF.

4Which of the following best describes NYHA functional class III?

A.No limitation of physical activity

B.Slight limitation; ordinary activity causes symptoms

C.Marked limitation; less than ordinary activity causes symptoms

D.Symptoms at rest

Explanation: NYHA class III is marked limitation of physical activity — comfortable at rest but less than ordinary activity causes dyspnea, fatigue, or palpitations. Class I is no limitation, II is slight, and IV is symptoms at rest or with minimal exertion.

5A 62-year-old with HFrEF (LVEF 30%) is on lisinopril 40 mg, carvedilol 25 mg BID, spironolactone 25 mg. Which medication change provides the greatest mortality benefit?

A.Increase carvedilol to 50 mg BID

B.Replace lisinopril with sacubitril-valsartan (ARNI)

C.Add digoxin

D.Add amlodipine

Explanation: PARADIGM-HF showed sacubitril-valsartan (ARNI) reduced CV death and HF hospitalization by 20% vs enalapril in HFrEF. The 2022 HF guideline recommends ARNI as first-line over ACEi/ARB (class I). After a 36-hour washout from ACEi, transition to ARNI is standard of care.

6Which of the following beta-blockers is NOT guideline-recommended for HFrEF mortality reduction?

A.Carvedilol

B.Metoprolol succinate

C.Bisoprolol

D.Metoprolol tartrate

Explanation: Only three beta-blockers have proven mortality benefit in HFrEF: carvedilol (COPERNICUS, CAPRICORN), metoprolol succinate (MERIT-HF), and bisoprolol (CIBIS-II). Metoprolol tartrate (short-acting) is NOT interchangeable and is NOT guideline-endorsed for HFrEF.

7A patient with HFrEF and diabetes mellitus type 2 has a recent initiation of an SGLT2 inhibitor. Which of the following is TRUE about SGLT2 inhibitors in HFrEF?

A.Only beneficial if diabetes is present

B.Reduce HF hospitalization and CV death regardless of diabetes status

C.Contraindicated if eGFR <60 mL/min/1.73 m2

D.Should replace ACEi/ARNI therapy

Explanation: DAPA-HF (dapagliflozin) and EMPEROR-Reduced (empagliflozin) demonstrated ~25% reduction in CV death or HF hospitalization in HFrEF irrespective of diabetes status. Both are class I recommendations. eGFR cutoffs have loosened (>=20 mL/min/1.73 m2 now acceptable).

8Which MRA is most likely to cause gynecomastia as an adverse effect?

A.Spironolactone

B.Eplerenone

C.Finerenone

D.Canrenone

Explanation: Spironolactone is a non-selective MRA and binds androgen and progesterone receptors, causing gynecomastia in ~10% of men. Eplerenone is selective for the mineralocorticoid receptor and has minimal anti-androgenic effect, making it preferred when gynecomastia occurs.

9A patient with HFrEF in sinus rhythm at HR 78 on maximal tolerated carvedilol 25 mg BID remains NYHA III. What is the best next step?

A.Add digoxin

B.Add ivabradine

C.Replace carvedilol with metoprolol succinate

D.Add amiodarone

Explanation: Ivabradine (SHIFT trial) reduces HF hospitalization in patients with HFrEF, sinus rhythm, HR >=70 bpm on maximally tolerated beta-blocker. It selectively inhibits the If current in the sinus node. Class IIa recommendation. Does not work in AF.

10Which HFrEF therapy has class I indication specifically in self-identified Black patients NYHA III-IV despite optimal GDMT?

A.Digoxin

B.Hydralazine plus isosorbide dinitrate

C.Amlodipine

D.Ranolazine

Explanation: A-HeFT showed hydralazine plus isosorbide dinitrate reduced mortality and hospitalization in self-identified Black patients with NYHA III-IV HFrEF on standard GDMT. Class I recommendation in this population. Also used in patients unable to tolerate ACEi/ARB/ARNI due to renal dysfunction or angioedema.

About the ABIM Advanced HF Exam

The ABIM Advanced Heart Failure and Transplant Cardiology (HFTC) subspecialty exam certifies cardiologists who have completed a 12-month ACGME-accredited HFTC fellowship. It covers chronic HF (HFrEF, HFmrEF, HFpEF) diagnosis and GDMT, acute decompensated HF, cardiogenic shock and temporary MCS, durable LVADs, cardiac transplantation and immunosuppression, rejection surveillance, and specialty HF etiologies including amyloidosis, HCM, sarcoidosis, and peripartum cardiomyopathy.

Questions

220 scored questions

Time Limit

~10-hour exam day (four ~2-hour modules)

Passing Score

Criterion-referenced scaled score (pass/fail; specific cut not published)

Exam Fee

~$2,990 application + exam fee (American Board of Internal Medicine (ABIM))

ABIM Advanced HF Exam Content Outline

25%

Chronic HF: Diagnosis and Management

HFrEF/HFmrEF/HFpEF classification, NYHA and ACC/AHA stages A-D, four-pillar GDMT (ARNI sacubitril-valsartan, BB carvedilol/metoprolol succinate/bisoprolol, MRA spironolactone/eplerenone, SGLT2i dapagliflozin/empagliflozin), ivabradine, hydralazine-nitrate, vericiguat, biomarkers (BNP/NT-proBNP), imaging (echo LVEF, cardiac MRI LGE, strain).

20%

ADHF and Cardiogenic Shock

IV loop diuretic strategies (DOSE trial), ultrafiltration (CARRESS-HF), nitroprusside/nitroglycerin, inotropes (dobutamine, milrinone), SCAI shock stages A-E, RHC interpretation (CI, PCWP, RA, PVR), INTERMACS profiles.

15%

Mechanical Circulatory Support

Temporary MCS: IABP, Impella 2.5/CP/5.0/5.5, VA-ECMO with Harlequin syndrome. Durable LVAD (HeartMate 3) physiology — continuous flow, narrow pulse pressure, GI bleeding from AVMs, aortic insufficiency, pump thrombosis (LDH, hemolysis), driveline infection, RV failure post-LVAD.

20%

Cardiac Transplantation

2018 UNOS allocation (status 1-6), listing criteria, absolute contraindications (PVR >5 Wood units unresponsive, active cancer/infection, substance use). Donor selection (brain death, DCD via TransMedics OCS, eCPR). Induction (basiliximab, ATG, alemtuzumab) and maintenance (tacrolimus + MMF + steroid taper). Transplant Candidate Risk Score.

10%

Post-Transplant Rejection and Surveillance

EMB surveillance early then non-invasive (AlloMap, HeartCare donor-derived cfDNA). ISHLT cellular rejection grading (1R/2R/3R) and AMR (pAMR1-3). Cardiac allograft vasculopathy (CAV), CMV prophylaxis, EBV-driven PTLD, skin cancer, post-transplant diabetes, CKD.

10%

HF Etiologies and Special Populations

Ischemic CM, HCM, amyloidosis (ATTR — tafamidis from ATTR-ACT, AL light chain). Sarcoidosis, myocarditis, hemochromatosis, peripartum cardiomyopathy, anthracycline cardiotoxicity. Palliative care and end-stage HF discussions.

How to Pass the ABIM Advanced HF Exam

What You Need to Know

Passing score: Criterion-referenced scaled score (pass/fail; specific cut not published)
Exam length: 220 questions
Time limit: ~10-hour exam day (four ~2-hour modules)
Exam fee: ~$2,990 application + exam fee

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

ABIM Advanced HF Study Tips from Top Performers

1Know the four-pillar GDMT for HFrEF cold: ARNI (sacubitril-valsartan) > ACEi/ARB, evidence-based BB (carvedilol, metoprolol succinate, bisoprolol), MRA (spironolactone, eplerenone), and SGLT2i (dapagliflozin, empagliflozin) regardless of diabetes. Add ivabradine when sinus rate >=70 on max BB and hydralazine-nitrate in Black patients or ACEi/ARB-intolerance.

2Memorize HFpEF evidence: SGLT2i (EMPEROR-Preserved, DELIVER) is now class I across the full EF spectrum; spironolactone (TOPCAT-Americas) class 2b; candesartan (CHARM-Preserved) for HF hospitalization. Always address BP, AF, obesity, and CAD.

3Master cardiogenic shock hemodynamics: SCAI A-E stages, cardiac index <2.2 L/min/m2 and PCWP >18 mmHg as the classic 'cold and wet' pattern, and the stepwise escalation from inotropes to IABP to Impella to VA-ECMO. Recognize Harlequin syndrome (upper-body hypoxia on peripheral VA-ECMO with recovering LV).

4For LVAD, learn the 'big four' complications: GI bleeding from AVMs (acquired von Willebrand), pump thrombosis (elevated LDH, power spikes), driveline infection, and aortic insufficiency. Understand continuous-flow physiology: narrow pulse pressure, Doppler BP, and suction events.

5Know transplant immunosuppression and rejection: induction options (basiliximab, ATG, alemtuzumab), maintenance tacrolimus + MMF + steroid taper, ISHLT cellular grades 1R/2R/3R, pAMR grading, and non-invasive surveillance with AlloMap gene expression and donor-derived cfDNA (HeartCare).

Frequently Asked Questions

Who is eligible for the ABIM Advanced Heart Failure and Transplant Cardiology exam?

Candidates must hold current ABIM certification in Cardiovascular Disease and must have completed a 12-month ACGME-accredited fellowship in Advanced Heart Failure and Transplant Cardiology (HFTC). A valid, unrestricted US medical license and verification of clinical competence from the program director are also required.

How often is the HFTC exam offered and how is it structured?

ABIM typically administers the HFTC subspecialty exam every two years (biennially). It is a single-day, computer-based exam at Pearson VUE containing approximately 220 single-best-answer MCQs delivered in four modules of roughly two hours each, with an overall ~10-hour exam day including tutorial and breaks.

What does the HFTC exam cost?

The ABIM application plus exam fee for Advanced Heart Failure and Transplant Cardiology is approximately $2,990 in 2026. Late fees apply after the regular deadline. Check the current ABIM fee schedule, as fees change annually.

What is the pass rate for the ABIM Advanced Heart Failure boards?

ABIM-reported first-time pass rates for HFTC have historically been in the 85-95% range, reflecting a fellowship-trained candidate pool. Pass rates for repeat takers are lower. See ABIM's annual pass-rate report for the most recent data.

What topics are highest yield on the HFTC boards?

Chronic HF management (four-pillar GDMT, HFpEF with SGLT2i), mechanical circulatory support (LVAD complications, temporary MCS selection), cardiac transplantation (UNOS allocation, immunosuppression, rejection grading), cardiogenic shock hemodynamics (SCAI stages, RHC), and specialty etiologies — especially ATTR amyloidosis and its treatment with tafamidis.

What references and resources are recommended for board prep?

The 2022 AHA/ACC/HFSA Heart Failure Guideline and 2023 Focused Update are essential. Also high-yield: ISHLT consensus documents (donor selection, rejection grading, LVAD management), Mann's Braunwald's Heart Disease HF chapters, Kirklin/Pagani on MCS, and targeted board review courses (MGH HF Board Review, HFSA Annual Scientific Meeting). Practice questions with detailed rationales are critical.

How do I maintain my HFTC certification after passing?

ABIM offers continuous MOC via the Longitudinal Knowledge Assessment (LKA) — roughly 30 questions per quarter, open-book — or a traditional 10-year recertification exam. You must also keep your underlying Cardiovascular Disease certification active and meet ABIM professional standing requirements.

Is HFTC certification worth it career-wise?

Yes for cardiologists in advanced HF/transplant, LVAD, or cardiogenic shock programs. Most major heart transplant and MCS centers now require or strongly prefer board certification for medical directorship and CMS-reporting roles. Certified advanced HF/transplant cardiologists frequently command a 10-20% compensation premium over general cardiologists in high-volume tertiary programs.