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.

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💉

Tylenol💊

Exercise🏃

Water💧

DangerousModerateSafe

Time to Effect

1-2 months

Duration

lifetime

Response Rate

40%

Remission Rate

Number Needed to Treat (NNT)

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

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💊

Exercise🏃

Water💧

DangerousModerateSafe

Time to Effect

1-3 months

Duration

lifetime

Response Rate

40%

Remission Rate

Number Needed to Treat (NNT)

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

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

Find Trials

Comparative Safety Scale(Higher is safer)

Cyanide☠️

Meth💀

Cigarettes🚬

Chemo☢️

Alcohol🍺

Morphine💊

Antibiotics💉

Tylenol💊

Exercise🏃

Water💧

DangerousModerateSafe

Time to Effect

3-6 months

Duration

lifetime

Response Rate

55%

Remission Rate

Number Needed to Treat (NNT)

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

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

Find Trials

Comparative Safety Scale(Higher is safer)

Cyanide☠️

Meth💀

Cigarettes🚬

Chemo☢️

Alcohol🍺

Morphine💊

Antibiotics💉

Tylenol💊

Exercise🏃

Water💧

DangerousModerateSafe

Time to Effect

1-3 months

Duration

lifetime

Response Rate

35%

Remission Rate

Number Needed to Treat (NNT)

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

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

Find Trials

Comparative Safety Scale(Higher is safer)

Cyanide☠️

Meth💀

Cigarettes🚬

Chemo☢️

Alcohol🍺

Morphine💊

Antibiotics💉

Tylenol💊

Exercise🏃

Water💧

DangerousModerateSafe

Time to Effect

1-3 months

Duration

lifetime

Response Rate

45%

Remission Rate

Number Needed to Treat (NNT)

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

Loop Diuretics (Furosemide)

65% Effectiveness• 85% Confidence• 65% Safety• 44 trials• 10K participants

MODERATE EvidenceExcellent ValueDose: 20-80 mg daily or BID

Find Trials

Comparative Safety Scale(Higher is safer)

Cyanide☠️

Meth💀

Cigarettes🚬

Chemo☢️

Alcohol🍺

Morphine💊

Antibiotics💉

Tylenol💊

Exercise🏃

Water💧

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