🫀 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.
Guideline-Directed Medical Therapy for Heart Failure (HFrEF new quadruple therapy)
Left ventricular ejection fraction LVEF (%)
Systolic BP (optional) (mmHg)
eGFR (optional) (mL/min/1.73m²)
Potassium (optional) (mmol/L)
When to use
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.
How it works
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.
Key points
- 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.
References
- Chinese Society of Cardiology. Guideline for the diagnosis and treatment of heart failure in China 2024.
- Heidenreich PA, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. Circulation 2022.
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.