{ "release_id": "f4600233112e1c27", "id": "cardio:guide-heart-failure-medicines", "owner": "cardio", "kind": "patient_guide", "slug": "heart-failure-medicines", "name": "Medicines for heart failure with a reduced ejection fraction, explained", "aliases": [], "atlases": [ "cardio" ], "summary_plain": "This guide explains the medicine classes used for heart failure with a reduced ejection fraction. It draws on a guideline summary, US government health pages, three trial reports and a registry report. It ends with questions to ask a care team.", "summary_technical": "A static guide to the medicine classes used for heart failure with a reduced ejection fraction. It gives no advice for one reader. It does not ask which medicines a reader takes.", "editorial_state": "draft", "last_substantive_edit": "2026-10-15", "last_evidence_check": "2026-10-15", "next_review_due": "2027-04-15", "identifiers": [], "navigation": { "cardio": { "condition-area": [ "heart-failure" ] } }, "payload": { "purpose": "explainer", "audience": "Adults with heart failure with a reduced ejection fraction (HFrEF), and the people who support them", "about": [ "cardio:heart-failure", "cardio:hfref", "cardio:hfref-four-medicine-regimen", "cardio:sacubitril-valsartan", "cardio:beta-blockers", "cardio:mineralocorticoid-receptor-antagonists", "cardio:sglt2-inhibitors" ], "reading_grade_target": 10, "scope_note": "Written from a guideline summary, US government health pages, three trial reports, a registry report and an entry in a medical vocabulary. The guideline summary and the NHLBI page date from 2022. This guide does not compare them with later guidance. It describes what the sources say and gives no advice for one person.", "warning_blocks": [], "sections": [ { "heading": "Heart failure and ejection fraction", "statements": [ { "id": "hf-1", "text": "Heart failure means that the heart cannot pump enough oxygen-rich blood to meet the body's needs.", "cites": [ { "snapshot_id": "cardio:medlineplus-heartfailure-2026-10-14", "locator": "Summary, What is heart failure, sentence 1" } ] }, { "id": "hf-2", "text": "It does not mean that the heart has stopped or is about to stop.", "cites": [ { "snapshot_id": "cardio:medlineplus-heartfailure-2026-10-14", "locator": "Summary, What is heart failure, sentence 2" } ] }, { "id": "hf-3", "text": "NHLBI says ejection fraction is the share of the left ventricle's blood that is pumped out with each heartbeat.", "cites": [ { "snapshot_id": "cardio:nhlbi-hf-diagnosis-2026-10-14", "locator": "Diagnosis, ejection fraction section, sentence 2, fragment 1 of 2" }, { "snapshot_id": "cardio:nhlbi-hf-diagnosis-2026-10-14", "locator": "Diagnosis, ejection fraction section, sentence 2, fragment 2 of 2" } ] }, { "id": "hf-4", "text": "NHLBI says an ejection fraction of 40% or less means heart failure with a reduced ejection fraction (HFrEF).", "cites": [ { "snapshot_id": "cardio:nhlbi-hf-diagnosis-2026-10-14", "locator": "Diagnosis, ejection fraction section, sentence 4, fragment 1 of 2" }, { "snapshot_id": "cardio:nhlbi-hf-diagnosis-2026-10-14", "locator": "Diagnosis, ejection fraction section, sentence 4, fragment 2 of 2" } ] }, { "id": "hf-5", "text": "An ACC summary of a 2022 guideline gives the same cut-off.", "cites": [ { "snapshot_id": "cardio:acc-hf2022-key-perspectives-2026-10-15", "locator": "Key perspective 1, classification list (HFrEF)" } ] }, { "id": "hf-6", "text": "MedlinePlus says there is no cure for heart failure, but that treatment can help people live longer with fewer symptoms.", "cites": [ { "snapshot_id": "cardio:medlineplus-heartfailure-2026-10-14", "locator": "Summary, What are the treatments, para 1, sentences 2 and 3" } ] }, { "id": "hf-7", "text": "It also says heart failure usually gets worse over time, even with treatment, so treatment is likely to be needed for life.", "cites": [ { "snapshot_id": "cardio:medlineplus-heartfailure-2026-10-14", "locator": "Summary, What are the treatments, para 2" } ] } ] }, { "heading": "The four classes in a 2022 guideline summary", "statements": [ { "id": "cl-1", "text": "An ACC summary of the 2022 heart failure guideline of the AHA, ACC and HFSA says guideline-directed medical therapy includes four classes of medicine.", "cites": [ { "claim": "cardio:claim-aha-acc-hfsa-2022-gdmt-four-classes" } ] }, { "id": "cl-2", "text": "The four classes are renin-angiotensin system inhibitors, beta blockers, mineralocorticoid receptor antagonists (MRAs) and SGLT2 inhibitors.", "cites": [ { "claim": "cardio:claim-aha-acc-hfsa-2022-gdmt-four-classes" } ] }, { "id": "cl-3", "text": "The summary says guideline-directed medical therapy should be considered for people with current or past heart failure, whatever their ejection fraction.", "cites": [ { "claim": "cardio:claim-aha-acc-hfsa-2022-gdmt-four-classes" } ] }, { "id": "cl-3b", "text": "The summary does not say that all four classes apply at every ejection fraction.", "cites": [ { "claim": "cardio:claim-aha-acc-hfsa-2022-gdmt-four-classes" } ] }, { "id": "cl-4", "text": "In the summary, the first-choice ARNI statement and the class 1a SGLT2 inhibitor statement apply to reduced ejection fraction.", "cites": [ { "claim": "cardio:claim-aha-acc-hfsa-2022-arni-first-line" }, { "claim": "cardio:claim-aha-acc-hfsa-2022-sglt2i-hfref" } ] }, { "id": "cl-5", "text": "The summary gives no doses, no order for starting the classes, and no class of recommendation for its four-class statement.", "cites": [ { "claim": "cardio:claim-aha-acc-hfsa-2022-gdmt-four-classes" } ] }, { "id": "cl-6", "text": "PubMed lists three corrections to the guideline, whose text this atlas has not read.", "cites": [ { "claim": "cardio:claim-aha-acc-hfsa-2022-gdmt-four-classes" } ] } ] }, { "heading": "Renin-angiotensin system inhibitors: ARNIs, ACE inhibitors and ARBs", "statements": [ { "id": "ras-1", "text": "This class has three types: ARNIs (angiotensin receptor-neprilysin inhibitors), ACE inhibitors and ARBs (angiotensin receptor blockers).", "cites": [ { "claim": "cardio:claim-aha-acc-hfsa-2022-gdmt-four-classes" } ] }, { "id": "ras-2", "text": "The summary recommends an ARNI as the first-choice medicine in this class to lower illness and death in HFrEF.", "cites": [ { "claim": "cardio:claim-aha-acc-hfsa-2022-arni-first-line" } ] }, { "id": "ras-3", "text": "It says an ACE inhibitor is recommended when an ARNI is not feasible; an ARB is recommended for people who cannot take an ACE inhibitor and when an ARNI is not feasible.", "cites": [ { "claim": "cardio:claim-aha-acc-hfsa-2022-arni-first-line" } ] }, { "id": "ras-4", "text": "For people with symptoms and HFrEF who tolerate an ACE inhibitor or ARB, it also recommends switching to an ARNI for a further drop in illness and death.", "cites": [ { "snapshot_id": "cardio:acc-hf2022-key-perspectives-2026-10-15", "locator": "Key perspective 2, sentence 4" } ] }, { "id": "ras-5", "text": "NHLBI lists ACE inhibitors and ARBs among medicines commonly used for HFrEF.", "cites": [ { "snapshot_id": "cardio:nhlbi-hf-treatment-2026-10-15", "locator": "Medicines, left-sided heart failure, lead-in" }, { "snapshot_id": "cardio:nhlbi-hf-treatment-2026-10-15", "locator": "Medicines, left-sided heart failure, blood vessel medicines" } ] }, { "id": "ras-6", "text": "It describes them as medicines that relax the blood vessels, which it says eases the heart's pumping.", "cites": [ { "snapshot_id": "cardio:nhlbi-hf-treatment-2026-10-15", "locator": "Medicines, left-sided heart failure, blood vessel medicines" } ] }, { "id": "ras-7", "text": "NHLBI's list names ACE inhibitors and ARBs but not ARNIs.", "cites": [ { "snapshot_id": "cardio:nhlbi-hf-treatment-2026-10-15", "locator": "Medicines, left-sided heart failure, blood vessel medicines" } ] }, { "id": "ras-8", "text": "NHLBI lists low blood pressure, a cough and a short-term drop in kidney function among the possible side effects of these medicines.", "cites": [ { "snapshot_id": "cardio:nhlbi-hf-treatment-2026-10-15", "locator": "Medicines, left-sided heart failure, blood vessel medicines, side effects" } ] } ] }, { "heading": "One trial of an ARNI", "statements": [ { "id": "pd-1", "text": "A 2014 trial enrolled 8442 people with class II, III or IV heart failure and an ejection fraction of 40% or less.", "cites": [ { "snapshot_id": "cardio:pubmed-25176015-2026-10-14", "locator": "Journal, PubDate, Year" }, { "snapshot_id": "cardio:pubmed-25176015-2026-10-14", "locator": "Abstract, METHODS, sentence 1, fragment 1 of 4" }, { "snapshot_id": "cardio:pubmed-25176015-2026-10-14", "locator": "Abstract, METHODS, sentence 1, fragment 2 of 4" } ] }, { "id": "pd-2", "text": "It compared an ARNI called LCZ696 with enalapril.", "cites": [ { "snapshot_id": "cardio:pubmed-25176015-2026-10-14", "locator": "Abstract, BACKGROUND, sentence 1" } ] }, { "id": "pd-3", "text": "Both groups also received recommended therapy.", "cites": [ { "snapshot_id": "cardio:pubmed-25176015-2026-10-14", "locator": "Abstract, METHODS, sentence 1, fragment 4 of 4" } ] }, { "id": "pd-4", "text": "The report says enalapril had improved survival in earlier studies of such patients.", "cites": [ { "snapshot_id": "cardio:pubmed-25176015-2026-10-14", "locator": "Abstract, BACKGROUND, sentence 2" } ] }, { "id": "pd-5", "text": "A company paid for the trial.", "cites": [ { "snapshot_id": "cardio:pubmed-25176015-2026-10-14", "locator": "Abstract, CONCLUSIONS, last sentence" }, { "snapshot_id": "cardio:ctgov-nct01035255-2026-10-14", "locator": "protocolSection.sponsorCollaboratorsModule.leadSponsor.class" } ] }, { "id": "pd-6", "text": "The trial was stopped early, after a median follow-up of 27 months, because its boundary for overwhelming benefit with the ARNI had been crossed.", "cites": [ { "snapshot_id": "cardio:pubmed-25176015-2026-10-14", "locator": "Abstract, RESULTS, sentence 1, fragment 1 of 2" }, { "snapshot_id": "cardio:pubmed-25176015-2026-10-14", "locator": "Abstract, RESULTS, sentence 1, fragment 2 of 2" } ] }, { "id": "pd-7", "text": "By then, cardiovascular death or admission to hospital for heart failure had happened in 21.8% of people taking the ARNI and 26.5% of those taking enalapril.", "cites": [ { "snapshot_id": "cardio:pubmed-25176015-2026-10-14", "locator": "Abstract, METHODS, sentence 2, fragment 1 of 2" }, { "snapshot_id": "cardio:pubmed-25176015-2026-10-14", "locator": "Abstract, RESULTS, sentence 2, fragment 1 of 3" }, { "snapshot_id": "cardio:pubmed-25176015-2026-10-14", "locator": "Abstract, RESULTS, sentence 2, fragment 2 of 3" } ] }, { "id": "pd-8", "text": "Low blood pressure and angioedema that was not serious were more common with the ARNI than with enalapril.", "cites": [ { "snapshot_id": "cardio:pubmed-25176015-2026-10-14", "locator": "Abstract, RESULTS, sentence 5, fragment 1 of 2" } ] }, { "id": "pd-9", "text": "Kidney impairment, high potassium and cough were less common with the ARNI.", "cites": [ { "snapshot_id": "cardio:pubmed-25176015-2026-10-14", "locator": "Abstract, RESULTS, sentence 5, fragment 2 of 2" } ] } ] }, { "heading": "Beta blockers", "statements": [ { "id": "bb-1", "text": "NHLBI lists beta blockers among the medicines commonly used for HFrEF.", "cites": [ { "claim": "cardio:claim-nhlbi-beta-blockers-heart-failure" } ] }, { "id": "bb-2", "text": "It describes beta blockers as medicines that slow the heart rate, which it says makes the heart's pumping easier.", "cites": [ { "claim": "cardio:claim-nhlbi-beta-blockers-heart-failure" } ] }, { "id": "bb-3", "text": "For HFrEF, NHLBI adds that medicines that slow the heart rate can help keep heart failure from worsening over the long term.", "cites": [ { "claim": "cardio:claim-nhlbi-beta-blockers-heart-failure" } ] }, { "id": "bb-4", "text": "NHLBI's side-effect list for this group, which includes ivabradine, mentions high blood pressure, fuzzy vision, bright halos and a heart rate that is slow or irregular.", "cites": [ { "snapshot_id": "cardio:nhlbi-hf-treatment-2026-10-15", "locator": "Medicines, left-sided heart failure, rate-slowing medicines, side effects" } ] } ] }, { "heading": "Mineralocorticoid receptor antagonists (MRAs)", "statements": [ { "id": "mra-1", "text": "NHLBI describes aldosterone antagonists, giving spironolactone as an example.", "cites": [ { "claim": "cardio:claim-nhlbi-aldosterone-antagonists-heart-failure" }, { "snapshot_id": "cardio:nhlbi-hf-treatment-2026-10-15", "locator": "Medicines, left-sided heart failure, diuretics and aldosterone antagonists, fragment 1 of 2" } ] }, { "id": "mra-1b", "text": "NHLBI lists them among medicines commonly used for HFrEF.", "cites": [ { "claim": "cardio:claim-nhlbi-aldosterone-antagonists-heart-failure" }, { "snapshot_id": "cardio:nhlbi-hf-treatment-2026-10-15", "locator": "Medicines, left-sided heart failure, lead-in" } ] }, { "id": "mra-2", "text": "The US National Library of Medicine's vocabulary used the heading aldosterone antagonists from 1966 to 2012, and has used mineralocorticoid receptor antagonists since 2013.", "cites": [ { "snapshot_id": "cardio:mesh-d000451-2026-10-14", "locator": "publicMeSHNote.@value" }, { "snapshot_id": "cardio:mesh-d000451-2026-10-14", "locator": "label.@value" } ] }, { "id": "mra-3", "text": "NHLBI describes diuretics and aldosterone antagonists as medicines that take extra sodium and fluid out of the body, so the heart has less blood to pump.", "cites": [ { "claim": "cardio:claim-nhlbi-aldosterone-antagonists-heart-failure" }, { "snapshot_id": "cardio:nhlbi-hf-treatment-2026-10-15", "locator": "Medicines, left-sided heart failure, diuretics and aldosterone antagonists, fragment 1 of 2" }, { "snapshot_id": "cardio:nhlbi-hf-treatment-2026-10-15", "locator": "Medicines, left-sided heart failure, diuretics and aldosterone antagonists, fragment 2 of 2" } ] }, { "id": "mra-4", "text": "NHLBI lists kidney disease and high levels of potassium as possible side effects of aldosterone antagonists.", "cites": [ { "claim": "cardio:claim-nhlbi-aldosterone-antagonists-heart-failure" }, { "snapshot_id": "cardio:nhlbi-hf-treatment-2026-10-15", "locator": "Medicines, left-sided heart failure, aldosterone antagonist side effects" } ] } ] }, { "heading": "SGLT2 inhibitors", "statements": [ { "id": "sg-1", "text": "NHLBI says SGLT-2 inhibitors and GLP agonists are two newer groups of medicines approved for people with diabetes, to lower blood sugar.", "cites": [ { "snapshot_id": "cardio:nhlbi-hf-treatment-2026-10-15", "locator": "Medicines, left-sided heart failure, newer medicines, sentence 1, fragment 1 of 2" }, { "snapshot_id": "cardio:nhlbi-hf-treatment-2026-10-15", "locator": "Medicines, left-sided heart failure, newer medicines, sentence 1, fragment 2 of 2" } ] }, { "id": "sg-2", "text": "On a page last updated in March 2022, NHLBI's list of newer medicines for HFrEF says these two groups may also reduce hospital admissions for heart failure, and that research on using them for heart failure was ongoing.", "cites": [ { "snapshot_id": "cardio:nhlbi-hf-treatment-2026-10-15", "locator": "Medicines, left-sided heart failure, newer medicines, sentence 2" }, { "snapshot_id": "cardio:nhlbi-hf-treatment-2026-10-15", "locator": "Medicines, left-sided heart failure, newer medicines, sentence 3" }, { "snapshot_id": "cardio:nhlbi-hf-treatment-2026-10-15", "locator": "Page footer, last updated" } ] }, { "id": "sg-3", "text": "The ACC summary recommends an SGLT2 inhibitor for people with symptoms and chronic HFrEF, to reduce hospital admissions and cardiovascular death, whether or not they have type 2 diabetes.", "cites": [ { "claim": "cardio:claim-aha-acc-hfsa-2022-sglt2i-hfref" } ] }, { "id": "sg-4", "text": "It adds that SGLT2 inhibitors can be beneficial in mildly reduced and preserved ejection fraction as well, with a class 2a recommendation.", "cites": [ { "claim": "cardio:claim-aha-acc-hfsa-2022-sglt2i-hfref" } ] }, { "id": "dp-1", "text": "A 2019 trial of the SGLT2 inhibitor dapagliflozin compared it with placebo in 4744 people with class II, III or IV heart failure and an ejection fraction of 40% or less.", "cites": [ { "claim": "cardio:claim-sglt2-hf-four-trials" }, { "snapshot_id": "cardio:pubmed-31535829-2026-10-14", "locator": "Journal, PubDate, Year" }, { "snapshot_id": "cardio:pubmed-31535829-2026-10-14", "locator": "Abstract, METHODS, sentence 1, fragment 1 of 4" }, { "snapshot_id": "cardio:pubmed-31535829-2026-10-14", "locator": "Abstract, METHODS, sentence 1, fragment 2 of 4" } ] }, { "id": "dp-2", "text": "Both groups also received recommended therapy.", "cites": [ { "snapshot_id": "cardio:pubmed-31535829-2026-10-14", "locator": "Abstract, METHODS, sentence 1, fragment 4 of 4" } ] }, { "id": "dp-3", "text": "A company paid for this trial.", "cites": [ { "snapshot_id": "cardio:pubmed-31535829-2026-10-14", "locator": "Abstract, CONCLUSIONS, last sentence" }, { "snapshot_id": "cardio:ctgov-nct03036124-2026-10-14", "locator": "protocolSection.sponsorCollaboratorsModule.leadSponsor.class" } ] }, { "id": "dp-3b", "text": "In this trial, worsening heart failure meant a hospitalization or an urgent visit that led to intravenous treatment for heart failure.", "cites": [ { "snapshot_id": "cardio:pubmed-31535829-2026-10-14", "locator": "Abstract, METHODS, sentence 2, fragment 1 of 2" } ] }, { "id": "dp-4", "text": "Over a median of 18.2 months, worsening heart failure or cardiovascular death occurred in 16.3% of people taking dapagliflozin and 21.2% of those taking placebo.", "cites": [ { "snapshot_id": "cardio:pubmed-31535829-2026-10-14", "locator": "Abstract, METHODS, sentence 2, fragment 1 of 2" }, { "snapshot_id": "cardio:pubmed-31535829-2026-10-14", "locator": "Abstract, METHODS, sentence 2, fragment 2 of 2" }, { "snapshot_id": "cardio:pubmed-31535829-2026-10-14", "locator": "Abstract, RESULTS, sentence 1, fragment 1 of 3" }, { "snapshot_id": "cardio:pubmed-31535829-2026-10-14", "locator": "Abstract, RESULTS, sentence 1, fragment 2 of 3" } ] }, { "id": "dp-5", "text": "The report says findings in people with diabetes were similar to those in people without diabetes.", "cites": [ { "snapshot_id": "cardio:pubmed-31535829-2026-10-14", "locator": "Abstract, RESULTS, sentence 4" } ] }, { "id": "dp-6", "text": "It also says adverse events related to volume depletion, kidney dysfunction and low blood sugar did not differ between the groups.", "cites": [ { "snapshot_id": "cardio:pubmed-31535829-2026-10-14", "locator": "Abstract, RESULTS, sentence 5" } ] }, { "id": "em-1", "text": "A 2020 trial of the SGLT2 inhibitor empagliflozin compared it with placebo in 3730 people with class II, III or IV heart failure and an ejection fraction of 40% or less.", "cites": [ { "claim": "cardio:claim-sglt2-hf-four-trials" }, { "snapshot_id": "cardio:pubmed-32865377-2026-10-14", "locator": "Journal, PubDate, Year" }, { "snapshot_id": "cardio:pubmed-32865377-2026-10-14", "locator": "Abstract, METHODS, sentence 1, fragment 1 of 4" }, { "snapshot_id": "cardio:pubmed-32865377-2026-10-14", "locator": "Abstract, METHODS, sentence 1, fragment 2 of 4" } ] }, { "id": "em-2", "text": "Both groups also received recommended therapy.", "cites": [ { "snapshot_id": "cardio:pubmed-32865377-2026-10-14", "locator": "Abstract, METHODS, sentence 1, fragment 4 of 4" } ] }, { "id": "em-3", "text": "Two companies paid for this trial.", "cites": [ { "snapshot_id": "cardio:pubmed-32865377-2026-10-14", "locator": "Abstract, CONCLUSIONS, last sentence" }, { "snapshot_id": "cardio:ctgov-nct03057977-2026-10-14", "locator": "protocolSection.sponsorCollaboratorsModule.leadSponsor.class" }, { "snapshot_id": "cardio:ctgov-nct03057977-2026-10-14", "locator": "protocolSection.sponsorCollaboratorsModule.collaborators[0].class" } ] }, { "id": "em-4", "text": "Over a median of 16 months, cardiovascular death or admission to hospital for worsening heart failure occurred in 19.4% of people taking empagliflozin and 24.7% of those taking placebo.", "cites": [ { "snapshot_id": "cardio:pubmed-32865377-2026-10-14", "locator": "Abstract, METHODS, sentence 2" }, { "snapshot_id": "cardio:pubmed-32865377-2026-10-14", "locator": "Abstract, RESULTS, sentence 1, fragment 1 of 3" }, { "snapshot_id": "cardio:pubmed-32865377-2026-10-14", "locator": "Abstract, RESULTS, sentence 1, fragment 2 of 3" } ] }, { "id": "em-5", "text": "The report says the effect was consistent whether or not people had diabetes.", "cites": [ { "snapshot_id": "cardio:pubmed-32865377-2026-10-14", "locator": "Abstract, RESULTS, sentence 2" } ] }, { "id": "em-6", "text": "It also says genital tract infection without complications was reported more often with empagliflozin.", "cites": [ { "snapshot_id": "cardio:pubmed-32865377-2026-10-14", "locator": "Abstract, RESULTS, sentence 5" } ] } ] }, { "heading": "How these medicines were used in one US registry", "statements": [ { "id": "reg-1", "text": "The CHAMP-HF registry report, published in 2018, covered 3518 outpatients in the United States who had chronic HFrEF and took at least one heart failure medicine by mouth.", "cites": [ { "snapshot_id": "cardio:pubmed-30025570-2026-10-14", "locator": "Journal, PubDate, Year" }, { "snapshot_id": "cardio:pubmed-30025570-2026-10-14", "locator": "Abstract, METHODS, sentence 1, fragment 1 of 2" }, { "snapshot_id": "cardio:pubmed-30025570-2026-10-14", "locator": "Abstract, METHODS, sentence 1, fragment 2 of 2" }, { "snapshot_id": "cardio:pubmed-30025570-2026-10-14", "locator": "Abstract, RESULTS, sentence 1" } ] }, { "id": "reg-3", "text": "The abstract names ACE inhibitors, ARBs, ARNIs, beta blockers and MRAs, but not SGLT2 inhibitors.", "cites": [ { "snapshot_id": "cardio:pubmed-30025570-2026-10-14", "locator": "Abstract, METHODS, sentence 2, fragment 1 of 2" }, { "snapshot_id": "cardio:pubmed-30025570-2026-10-14", "locator": "Abstract, METHODS, sentence 2, fragment 2 of 2" } ] }, { "id": "reg-4", "text": "Among eligible patients, 27% were not prescribed an ACE inhibitor, ARB or ARNI, 33% a beta blocker, and 67% an MRA.", "cites": [ { "claim": "cardio:claim-champ-hf-medicine-gaps" } ] }, { "id": "reg-5", "text": "Among those prescribed them, 17% were taking target doses of an ACE inhibitor or ARB, 14% of an ARNI, 28% of a beta blocker and 77% of an MRA.", "cites": [ { "claim": "cardio:claim-champ-hf-medicine-gaps" } ] }, { "id": "reg-6", "text": "Among patients eligible for all these classes, 1% were taking target doses of an ACE inhibitor, ARB or ARNI, a beta blocker and an MRA at once.", "cites": [ { "claim": "cardio:claim-champ-hf-medicine-gaps" } ] }, { "id": "reg-7", "text": "In its adjusted models, older age, lower blood pressure, more severe functional class, kidney insufficiency and a recent hospital stay for heart failure generally went with lower medication use or dose.", "cites": [ { "snapshot_id": "cardio:pubmed-30025570-2026-10-14", "locator": "Abstract, RESULTS, sentence 6, fragment 1 of 2" }, { "snapshot_id": "cardio:pubmed-30025570-2026-10-14", "locator": "Abstract, RESULTS, sentence 6, fragment 2 of 2" } ] }, { "id": "reg-8", "text": "The abstract does not say why a medicine was not prescribed.", "cites": [ { "claim": "cardio:claim-champ-hf-medicine-gaps" } ] } ] } ], "checklists": [], "questions": [ { "text": "Which of these four medicine classes are part of my treatment?", "grounded_in": [ "cl-1", "cl-2" ] }, { "text": "Which of these classes apply to my type of heart failure, and why?", "grounded_in": [ "cl-3", "cl-3b", "cl-4", "hf-4" ] }, { "text": "What is my ejection fraction, and does it fall in the range these sources call reduced?", "grounded_in": [ "hf-3", "hf-4" ] }, { "text": "Would an ARNI be an option for me, or am I already taking a medicine from this class?", "grounded_in": [ "ras-2", "ras-3", "ras-4" ] }, { "text": "Does the SGLT2 inhibitor recommendation apply to me, with or without diabetes?", "grounded_in": [ "sg-3", "sg-4" ] }, { "text": "What side effects should I watch for with each of my medicines?", "grounded_in": [ "ras-8", "bb-4", "mra-4" ] }, { "text": "How are the doses of my medicines chosen?", "grounded_in": [ "reg-5", "reg-7" ] }, { "text": "Do the results of these trials apply to people like me?", "grounded_in": [ "pd-1", "dp-1", "em-1" ] } ] }, "content_digest": "6580c49045bb58d8e87b5c1554ddae0ad03b61d0fe387dfafd54d65de96257d0", "review": { "content_digest": "6580c49045bb58d8e87b5c1554ddae0ad03b61d0fe387dfafd54d65de96257d0", "current": [], "conflicting": [], "stale": [], "inactive": [] }, 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