Condition

Dilated Cardiomyopathy

Heart muscle becomes enlarged and weakened

25M
People Affected
80
Active Trials
250K
New Cases/Year
60K
Deaths/Year

Treatment Rankings

Ranked by evidence volume first. Medicine has spent centuries ranking things by vibes. This is an improvement.

1
SGLT2 Inhibitors (e.g., Dapagliflozin)
92% Effectiveness• 95% Confidence• 65% Safety• 25 trials• 25K participants
HIGH EvidenceGood ValueDose: Dapagliflozin 10mg daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
65
DangerousModerateSafe

Time to Effect

1-4 weeks

Duration

lifetime

Response Rate

70%

Remission Rate

5%

Number Needed to Treat (NNT)

20

Number Needed to Harm (NNH)

15

Common Side Effects:

Genital mycotic infections: 8%
Urinary tract infections: 6%
Volume depletion/Hypotension: 3%

Annual Cost of Care

Drug Cost

$6,000

Monitoring

$700

Side Effects

$150

Total Annual

$6,850

Cost-Effectiveness

GOOD

QALYs Gained

0.5

ICER

$40,000/QALY

Cost per Remission

$137,000

Cost per Responder

$9,786

Treatment Outcomes
Efficacy Outcomes
Overall Effectiveness
+92%
Response Rate
+70%
Remission Rate
+5%
Common Side Effects
Genital mycotic infections
+8%
Urinary tract infections
+6%
Volume depletion/Hypotension
+3%

Clinical Trial Phases:

Phase 3Phase 4
2
ARNI (Sacubitril/Valsartan)
90% Effectiveness• 95% Confidence• 65% Safety• 1 trials• 25K participants
HIGH EvidenceGood ValueDose: Sacubitril/Valsartan 24/26mg BID up to 97/103mg BID
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
65
DangerousModerateSafe

Time to Effect

2-8 weeks

Duration

lifetime

Response Rate

75%

Remission Rate

5%

Number Needed to Treat (NNT)

21

Number Needed to Harm (NNH)

25

Common Side Effects:

Hypotension: 18%
Hyperkalemia: 8%
Cough: 7%
Angioedema: 0.5%

Annual Cost of Care

Drug Cost

$6,200

Monitoring

$700

Side Effects

$200

Total Annual

$7,100

Cost-Effectiveness

GOOD

QALYs Gained

0.5

ICER

$50,000/QALY

Cost per Remission

$142,000

Cost per Responder

$9,467

Treatment Outcomes
Primary Outcomes
N-terminal pro-B-type natriuretic peptide (NT-proBNP)1600 pg/mL
-27% (-432 pg/mL)
NYHA Functional ClassClass 2.7 (average)
-18.5% (-0.5 class)
Left Ventricular Ejection Fraction (LVEF)30%
+13.3% (+4 percentage points)
Systolic Blood Pressure125 mmHg
-6.4% (-8 mmHg)
Secondary Benefits
Kansas City Cardiomyopathy Questionnaire (KCCQ) Clinical Summary Score60/100 points
+13.3% (+8 points)
6-Minute Walk Test Distance300 meters
+8.3% (+25 meters)
Common Side Effects
Hypotension
+18%
Hyperkalemia
+8%
Cough
+7%

Clinical Trial Phases:

Phase 3Phase 4
3
Mineralocorticoid Receptor Antagonists (e.g., Spironolactone)
85% Effectiveness• 90% Confidence• 65% Safety• 1 trials• 15K participants
HIGH EvidenceExcellent ValueDose: Spironolactone 12.5-50mg daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
65
DangerousModerateSafe

Time to Effect

2-6 weeks

Duration

lifetime

Response Rate

60%

Remission Rate

3%

Number Needed to Treat (NNT)

18

Number Needed to Harm (NNH)

30

Common Side Effects:

Hyperkalemia: 15%
Gynecomastia (Spironolactone): 10%
Hypotension: 7%

Annual Cost of Care

Drug Cost

$30

Monitoring

$500

Side Effects

$130

Total Annual

$660

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.7

Cost per Remission

$22,000

Cost per Responder

$1,100

Treatment Outcomes
Primary Outcomes
N-terminal pro-B-type Natriuretic Peptide (NT-proBNP)2000 pg/mL
-30% (-600 pg/mL)
NYHA Functional ClassNYHA Class 2.8 (average)
-14.3% (-0.4 NYHA class)
Left Ventricular Ejection Fraction (LVEF)30%
+10% (+3 percentage points)
Hospitalization for Heart FailureAnnual event rate: 15%
-30% (-4.5 percentage points in annual rate)
Secondary Benefits
Kansas City Cardiomyopathy Questionnaire (KCCQ) Overall Summary Score60 points (out of 100)
+10% (+6 points)
6-Minute Walk Test Distance300 meters
+10% (+30 meters)
Left Ventricular End-Diastolic Volume Index (LVEDVI)90 mL/m^2
-5% (-4.5 mL/m^2)
Common Side Effects
Hyperkalemia
+15%
Gynecomastia (Spironolactone)
+10%
Hypotension
+7%

Clinical Trial Phases:

Phase 3Phase 4
4
Beta-blockers (e.g., Carvedilol)
82% Effectiveness• 95% Confidence• 70% Safety• 1 trials• 70K participants
HIGH EvidenceExcellent ValueDose: Carvedilol 3.125mg BID up to 25mg BID
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
70
DangerousModerateSafe

Time to Effect

4-12 weeks

Duration

lifetime

Response Rate

70%

Remission Rate

5%

Number Needed to Treat (NNT)

22

Number Needed to Harm (NNH)

20

Common Side Effects:

Dizziness: 15%
Fatigue: 15%
Bradycardia: 10%
Hypotension: 10%

Annual Cost of Care

Drug Cost

$50

Monitoring

$700

Side Effects

$120

Total Annual

$870

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.9

Cost per Remission

$17,400

Cost per Responder

$1,243

Treatment Outcomes
Primary Outcomes
Left Ventricular Ejection Fraction (LVEF)25%
+40% (+10 percentage points (e.g., to 35%))
N-terminal pro-B-type Natriuretic Peptide (NT-proBNP)2000 pg/mL
-40% (-800 pg/mL)
NYHA Functional ClassClass III (mean score ~3.2 on 1-4 scale)
-22% (-0.7 score points (e.g., to Class II-III, mean ~2.5))
6-Minute Walk Test Distance300 meters
+17% (+50 meters)
Secondary Benefits
Kansas City Cardiomyopathy Questionnaire (KCCQ) Overall Summary Score50/100 points
+20% (+10 points)
Resting Heart Rate85 bpm
-18% (-15 bpm)
Left Ventricular End-Diastolic Volume Index (LVEDVi)160 mL/m^2
-9% (-15 mL/m^2)
Common Side Effects
Dizziness
+15%
Fatigue
+15%
Bradycardia
+10%

Clinical Trial Phases:

Phase 3Phase 4
5
ACE Inhibitors (e.g., Lisinopril)
80% Effectiveness• 95% Confidence• 70% Safety• 500 trials• 100K participants
HIGH EvidenceExcellent ValueDose: Lisinopril 2.5-40mg daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
70
DangerousModerateSafe

Time to Effect

2-4 weeks

Duration

lifetime

Response Rate

65%

Remission Rate

4%

Number Needed to Treat (NNT)

25

Number Needed to Harm (NNH)

10

Common Side Effects:

Cough: 10%
Hypotension: 7%
Dizziness: 6%
Hyperkalemia: 3%
Angioedema: 0.3%

Annual Cost of Care

Drug Cost

$40

Monitoring

$700

Side Effects

$100

Total Annual

$840

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.8

Cost per Remission

$21,000

Cost per Responder

$1,292

Treatment Outcomes
Efficacy Outcomes
Overall Effectiveness
+80%
Response Rate
+65%
Remission Rate
+4%
Common Side Effects
Cough
+10%
Hypotension
+7%
Dizziness
+6%

Clinical Trial Phases:

Phase 3Phase 4