Condition

Heart Failure

Chronic condition where heart cannot pump enough blood

64M
People Affected
150
Active Trials
2.6M
New Cases/Year
300K
Deaths/Year

Treatment Rankings

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

1
Dapagliflozin
88% Effectiveness• 92% Confidence• 65% Safety• 109 trials• 25K participants
HIGH EvidenceGood ValueDose: 10 mg once daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
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65
DangerousModerateSafe

Time to Effect

1-2 months

Duration

lifetime

Response Rate

40%

Remission Rate

%

Number Needed to Treat (NNT)

21

Common Side Effects:

Genital mycotic infections: 7%
Urinary tract infections: 5%
Hypotension: 2%

Annual Cost of Care

Drug Cost

$6,500

Monitoring

$750

Side Effects

$150

Total Annual

$7,400

Cost-Effectiveness

GOOD

QALYs Gained

0.15

ICER

$50,000/QALY

Cost per Responder

$18,500

Treatment Outcomes
Primary Outcomes
N-terminal pro-B-type natriuretic peptide (NT-proBNP)2400 pg/mL
-17.5% (-420 pg/mL)
Kansas City Cardiomyopathy Questionnaire - Total Symptom Score (KCCQ-TSS)60 points (range 0-100)
+7.5% (+4.5 points)
Body Weight85 kg
-2.5% (-2.1 kg)
Secondary Benefits
Glycated Hemoglobin A1c (HbA1c)7.8%
-10.2% (-0.8%)
Serum Uric Acid6.5 mg/dL
-10% (-0.65 mg/dL)
Systolic Blood Pressure135 mmHg
-3% (-4 mmHg)
Common Side Effects
Genital mycotic infections
+7%
Urinary tract infections
+5%
Hypotension
+2%

Clinical Trial Phases:

Phase 3Phase 4
2
Sacubitril/Valsartan
87% Effectiveness• 92% Confidence• 65% Safety• 132 trials• 15K participants
HIGH EvidenceGood ValueDose: 49/51 mg BID up to 97/103 mg BID
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Comparative Safety Scale(Higher is safer)

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

Time to Effect

1-3 months

Duration

lifetime

Response Rate

40%

Remission Rate

%

Number Needed to Treat (NNT)

21

Common Side Effects:

Hypotension: 16%
Hyperkalemia: 11%
Renal impairment: 10%
Cough: 9%
Angioedema: 0.5%

Annual Cost of Care

Drug Cost

$7,800

Monitoring

$850

Side Effects

$250

Total Annual

$8,900

Cost-Effectiveness

GOOD

QALYs Gained

0.3

ICER

$60,000/QALY

Cost per Responder

$22,250

Treatment Outcomes
Primary Outcomes
Composite of Cardiovascular Death or First Heart Failure HospitalizationAnnual event rate: ~26.5% (in control group over follow-up)
-20% (-4.7 percentage points (reduction in annual event rate))
N-terminal pro-B-type natriuretic peptide (NT-proBNP)1600 pg/mL
-28% (-448 pg/mL)
Kansas City Cardiomyopathy Questionnaire (KCCQ) Clinical Summary Score55 points (on a 0-100 scale, higher is better)
+4.5% (+2.5 points)
Secondary Benefits
All-cause mortalityAnnual event rate: ~19.8% (in control group over follow-up)
-14% (-2.8 percentage points (reduction in annual event rate))
Annual Rate of eGFR Decline-1.8 mL/min/1.73m^2 per year (typical decline rate in HF)
+27.8% (+0.5 mL/min/1.73m^2 per year (slower decline))
Kansas City Cardiomyopathy Questionnaire (KCCQ) Physical Limitation Score45 points (on a 0-100 scale, higher is better)
+6.7% (+3 points)
Common Side Effects
Hypotension
+16%
Hyperkalemia
+11%
Renal impairment
+10%

Clinical Trial Phases:

Phase 3Phase 4
3
Beta-blockers (Carvedilol, Metoprolol succinate)
83% Effectiveness• 95% Confidence• 70% Safety• 16 trials• 30K participants
HIGH EvidenceExcellent ValueDose: Carvedilol 3.125 mg BID up to 25-50 mg BID; Metoprolol succinate 12.5-25 mg daily up to 200 mg daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
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70
DangerousModerateSafe

Time to Effect

3-6 months

Duration

lifetime

Response Rate

55%

Remission Rate

%

Number Needed to Treat (NNT)

35

Common Side Effects:

Fatigue: 15%
Bradycardia: 8%
Hypotension: 7%
Dizziness: 7%

Annual Cost of Care

Drug Cost

$200

Monitoring

$600

Side Effects

$50

Total Annual

$850

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.8

ICER

$8,000/QALY

Cost per Responder

$1,545

Treatment Outcomes
Primary Outcomes
Left Ventricular Ejection Fraction (LVEF)30%
+23.3% (+7 percentage points)
NYHA Functional ClassNYHA Class score: 3/4
-33.3% (-1 class point (e.g., from Class III to II))
Heart Rate85 bpm
-23.5% (-20 bpm)
N-terminal pro-B-type natriuretic peptide (NT-proBNP)2500 pg/mL
-35% (-875 pg/mL)
Secondary Benefits
Kansas City Cardiomyopathy Questionnaire (KCCQ) Overall Summary ScoreKCCQ Overall Summary Score: 45/100
+17.8% (+8 points)
6-Minute Walk Test (6MWT) Distance300 meters
+15% (+45 meters)
Systolic Blood Pressure130 mmHg
-7.7% (-10 mmHg)
Common Side Effects
Fatigue
+15%
Bradycardia
+8%
Hypotension
+7%

Clinical Trial Phases:

Phase 3Phase 4
4
Mineralocorticoid Receptor Antagonists (Spironolactone)
77% Effectiveness• 90% Confidence• 70% Safety• 10 trials• 15K participants
HIGH EvidenceExcellent ValueDose: 12.5 mg daily up to 25-50 mg 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

1-3 months

Duration

lifetime

Response Rate

35%

Remission Rate

%

Number Needed to Treat (NNT)

16

Common Side Effects:

Hyperkalemia: 8%
Gynecomastia: 12%
Renal impairment: 4%

Annual Cost of Care

Drug Cost

$180

Monitoring

$900

Side Effects

$150

Total Annual

$1,230

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.4

ICER

$8,000/QALY

Cost per Responder

$3,514

Treatment Outcomes
Primary Outcomes
All-cause mortality (1-year)35% (cumulative risk)
-30% (-10.5 percentage points)
Heart failure hospitalization (1-year)30% (cumulative risk)
-35% (-10.5 percentage points)
NT-proBNP2500 pg/mL
-40% (-1000 pg/mL)
Left Ventricular Ejection Fraction (LVEF)30%
+13.3% (+4 percentage points)
Secondary Benefits
Serum Potassium4.0 mEq/L
+7.5% (+0.3 mEq/L)
eGFR60 mL/min/1.73m^2
-12% (-7.2 mL/min/1.73m^2)
Systolic Blood Pressure130 mmHg
-7.7% (-10 mmHg)
Common Side Effects
Hyperkalemia
+8%
Gynecomastia
+12%
Renal impairment
+4%

Clinical Trial Phases:

Phase 3Phase 4
5
ACE Inhibitors (Lisinopril) / ARBs (Valsartan)
78% Effectiveness• 95% Confidence• 70% Safety• 100 trials• 50K participants
HIGH EvidenceExcellent ValueDose: Lisinopril 2.5-5 mg daily up to 20-40 mg daily; Valsartan 20-40 mg BID up to 160 mg 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

1-3 months

Duration

lifetime

Response Rate

45%

Remission Rate

%

Number Needed to Treat (NNT)

25

Common Side Effects:

Cough: 12%
Hypotension: 8%
Dizziness: 8%
Hyperkalemia: 4%
Angioedema: 0.2%

Annual Cost of Care

Drug Cost

$150

Monitoring

$600

Side Effects

$75

Total Annual

$825

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.9

ICER

$5,000/QALY

Cost per Responder

$1,833

Treatment Outcomes
Efficacy Outcomes
Overall Effectiveness
+78%
Response Rate
+45%
Common Side Effects
Cough
+12%
Hypotension
+8%
Dizziness
+8%

Clinical Trial Phases:

Phase 3Phase 4
6
Loop Diuretics (Furosemide)
65% Effectiveness• 85% Confidence• 65% Safety• 44 trials• 10K participants
MODERATE EvidenceExcellent ValueDose: 20-80 mg daily or BID
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Comparative Safety Scale(Higher is safer)

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

Time to Effect

immediate

Duration

lifetime (as needed)

Response Rate

75%

Remission Rate

%

Common Side Effects:

Electrolyte imbalance (hypokalemia, hyponatremia): 15%
Dehydration/Hypotension: 8%
Dizziness: 7%

Annual Cost of Care

Drug Cost

$100

Monitoring

$800

Side Effects

$150

Total Annual

$1,050

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.2

ICER

$5,000/QALY

Cost per Responder

$1,400

Treatment Outcomes
Primary Outcomes
Dyspnea Severity (VAS)65 mm (0-100 mm scale)
-46% (-30 mm)
Body Weight80 kg (fluid overloaded)
-4% (-3 kg)
Ankle Circumference28 cm (due to edema)
-7% (-2 cm)
N-terminal pro-B-type Natriuretic Peptide (NT-proBNP)5000 pg/mL
-30% (-1500 pg/mL)
Secondary Benefits
24-Hour Urine Output1.2 L/day
+125% (+1.5 L/day)
KCCQ Overall Summary Score35 points (0-100 scale, lower is worse)
+29% (+10 points)
6-Minute Walk Test Distance250 meters
+20% (+50 meters)
Common Side Effects
Electrolyte imbalance (hypokalemia, hyponatremia)
+15%
Dehydration/Hypotension
+8%
Dizziness
+7%

Clinical Trial Phases:

Phase 4