Guideline-Directed Medical Therapy for Heart Failure (HFrEF new quadruple therapy) — free guideline decision tool
This tool classifies heart failure by LVEF and frames the HFrEF 'new quadruple therapy' (ARNI + β-blocker + MRA + SGLT2i), with cautions by blood pressure, renal function, and potassium.
Open guideline tool →Guideline-based
Implements the decision logic from published clinical guidelines.
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No installation. Enter the patient's values and get a guideline recommendation instantly.
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Nothing is uploaded. Results are for licensed clinicians only.
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Left ventricular ejection fraction LVEF | 32 % |
|---|---|
| Systolic BP (optional) | 110 mmHg |
| eGFR (optional) | 60 mL/min/1.73m² |
| Potassium (optional) | 4.2 mmol/L |
→Treatment directionNew quadruple therapy: ARNI + β-blocker + MRA + SGLT2i
- HF classification：HFrEF (LVEF ≤ 40%)
- Core regimen：Start the 'new quadruple therapy' early in combination and titrate to target/maximum tolerated: (1) ARNI (sacubitril/valsartan, preferred over ACEi/ARB; ACEi if not usable, ARB if ACEi not tolerated); (2) evidence-based β-blocker (bisoprolol/carvedilol/metoprolol succinate); (3) MRA (spironolactone/eplerenone); (4) SGLT2i (dapagliflozin/empagliflozin, regardless of diabetes). Add a loop diuretic symptomatically for congestion.
- Drug cautions：Switching to ARNI requires stopping ACEi ≥ 36 h; monitor BP, potassium, and renal function during initiation and titration
Common questions
What is Guideline-Directed Medical Therapy for Heart Failure (HFrEF new quadruple therapy)?
This tool classifies heart failure by LVEF and frames the HFrEF 'new quadruple therapy' (ARNI + β-blocker + MRA + SGLT2i), with cautions by blood pressure, renal function, and potassium.
How is Guideline-Directed Medical Therapy for Heart Failure (HFrEF new quadruple therapy) calculated? What is the core formula?
LVEF ≤ 40% → ARNI + β-blocker + MRA + SGLT2i titrated to target; 41–49% → SGLT2i preferred; ≥ 50% → SGLT2i + diuresis + comorbidities. Flags low SBP, K ≥ 5.0, and eGFR < 30.
When is Guideline-Directed Medical Therapy for Heart Failure (HFrEF new quadruple therapy) used?
Use to set the core regimen: HFrEF (LVEF ≤ 40%) starts all four pillars early, HFmrEF prefers an SGLT2i, and HFpEF centers on SGLT2i plus diuresis and comorbidity management.
What are the key clinical points for Guideline-Directed Medical Therapy for Heart Failure (HFrEF new quadruple therapy)?
Switching to ARNI requires stopping an ACEi at least 36 hours beforehand to avoid angioedema, and the four pillars are combined early rather than sequentially. (original synthesis · not guideline verbatim) MRA/RASi require potassium and renal-function monitoring; MRA is generally avoided at eGFR < 30. If LVEF stays ≤ 35% with symptoms after optimized therapy, evaluate for ICD/CRT.
What are the limits and cautions when using Guideline-Directed Medical Therapy for Heart Failure (HFrEF new quadruple therapy)?
For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
How is Guideline-Directed Medical Therapy for Heart Failure (HFrEF new quadruple therapy) calculated in practice? Can you show a worked example?
Inputs: Left ventricular ejection fraction LVEF 32 %, Systolic BP (optional) 110 mmHg, eGFR (optional) 60 mL/min/1.73m², Potassium (optional) 4.2 mmol/L → Result: Treatment direction New quadruple therapy: ARNI + β-blocker + MRA + SGLT2i（HF classification: HFrEF (LVEF ≤ 40%), Core regimen: Start the 'new quadruple therapy' early in combination and titrate to target/maximum tolerated: (1) ARNI (sacubitril/valsartan, preferred over ACEi/ARB; ACEi if not usable, ARB if ACEi not tolerated); (2) evidence-based β-blocker (bisoprolol/carvedilol/metoprolol succinate); (3) MRA (spironolactone/eplerenone); (4) SGLT2i (dapagliflozin/empagliflozin, regardless of diabetes). Add a loop diuretic symptomatically for congestion., Drug cautions: Switching to ARNI requires stopping ACEi ≥ 36 h; monitor BP, potassium, and renal function during initiation and titration）
Run Guideline-Directed Medical Therapy for Heart Failure (HFrEF new quadruple therapy) now
This tool classifies heart failure by LVEF and frames the HFrEF 'new quadruple therapy' (ARNI + β-blocker + MRA + SGLT2i), with cautions by blood pressure, renal function, and potassium.
Open guideline tool →For licensed clinicians. Not a substitute for clinical judgement.
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