Ejection fraction — the number that decides the whole regimen 41–49% (mildly reduced)
hf-mrefNo one has reached this rule yetSGLT2 inhibitor first; the other three reasonable to add
No clinician has signed off this rule yet. It reflects our reading of the guidelines cited below, which has not been independently checked.
Word for word, as generated for the example person below. Figures in the text are theirs.
Your ejection fraction is 45%, in the mildly-reduced band. An SGLT2 inhibitor is the clearest recommendation; the other three classes are reasonable to add.
Dapagliflozin and empagliflozin reduced heart failure hospitalizations across this range, regardless of diabetes. An ARNI (or ACE inhibitor/ARB), a heart-failure beta blocker, and an MRA all have supportive but weaker evidence in this band than they do below 40% — they're reasonable, and they become clearly indicated if your ejection fraction drops further. Because this band sits on a boundary, it's worth repeating the echocardiogram rather than assuming the number is fixed.
Outcome-provenTested in randomised trials measuring heart attacks, strokes, or death, not a stand-in for them.· Class 2a/2b· Level B-R· checked 2026-09-12
2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure (Circulation) · Class 2a/2b
“Heart failure, mildly reduced” — an illustrative profile, not a real user.
Asked after: Heart failure
Cited by the recommendations above.
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Runs in lib/engine/heartFailurePathway.ts as hf-mref.