Settings
Display
Both options are off by default and are stored only in this browser.
Show the verbatim source wording boxes on the Pathway modules and on the Framework page. The Evidence matrix and the Therapy plan always show their quotations, whatever this is set to.
Show notes about how the tool was made: which decisions the physician reviewer has made, which items have been reviewed and which have not yet, and the open questions on the Framework page.
Adjustable cutoffs
Every threshold the tool uses, with its guideline default and the source wording. Values are stored only in this browser. The ranges used by the tool’s Simulate button are listed at the bottom (read-only).
Blood pressure
When low blood pressure delays starting or uptitrating vasodilating therapy.
Default 100 mmHg · allowed 80–120 · ESC 2026 §6.1.4.1 (SBP <100 mmHg)
Default 90 mmHg · allowed 70–110 · ESC 2026 §7.5.8 (SBP <90 with hypoperfusion)
Heart rate
Beta-blocker uptitration and ivabradine thresholds.
Default 50 bpm · allowed 40–65 · ESC 2026 Supplementary Table S6
Default 70 bpm · allowed 60–90 · ESC 2026 Rec Table 5 (>70 bpm)
Potassium
When hyperkalaemia delays MRA/RAAS-inhibitor starts or triggers dose reduction or holding.
Default 5 mmol/L · allowed 4.5–5.5 · ESC 2026 §6.1.2.2 (≥5.0 mmol/L)
Default 5.5 mmol/L · allowed 5–6 · ESC 2026 §6.1.2.2 (>5.5 mmol/L)
Default 6 mmol/L · allowed 5.5–6.5 · ESC 2026 §6.1.6 (>5.5 or >6 mmol/L)
Tolerated change in kidney function after starting therapy
A small rise in creatinine (fall in eGFR) after starting an ACE-I/ARB/ARNI, MRA or SGLT2 inhibitor is expected and should not by itself prompt stopping. Sources judge it differently: choose which measure the tool uses.
Default: creatinine rise <50% with eGFR staying above 15. This default is used for every class (ACE-I/ARB/ARNI, MRA, SGLT2 inhibitor).
Default 50 % · allowed 20–60 · ESC 2026 §10.3 (<50%)
Default 30 % · allowed 10–50 · ESC 2026 Suppl. Tables S4/S5; KDIGO 2026 HF (<30%)
Default 15 mL/min/1.73 m² · allowed 10–30 · ESC 2026 §10.3 (>15)
Kidney-function cutoffs per drug (initiation floors, continuation floors, dialysis status) are not user-adjustable; they follow the FDA label where one exists, then the guideline. See each drug profile and the matrix for the sources and for every competing statement.
Simulate: how random cases are drawn
The Simulate button on the tool fills every input with a random case and recalculates, so you can see how different inputs change the output. These ranges are shown for information only and cannot be edited. They are teaching choices that keep every value physiologically plausible and spread cases across all kidney stages, phenotypes and treatment states; they are not published frequencies, and the cases are not real patients.
Heart failure
- Care setting
- acute / in-hospital 20%, otherwise chronic / outpatient
- Phenotype
- HFrEF 70%, HFpEF 30%
- LVEF
- HFrEF: 10–29% (35%), 30–39% (35%), 40–49% (30%); HFpEF: 50–70% (100%)
- NYHA class
- I 10%, II 40%, III 40%, IV 10%
- Congestion
- outpatient: none 65%, mild 25%, overt 10%; in-hospital: none 15%, mild 35%, overt 50%
- Hypoperfusion / shock
- in-hospital cases only, 12%
Vitals and rhythm
- Systolic BP
- 85–98 mmHg (10%), 100–160 mmHg (85%), 161–190 mmHg (5%)
- Diastolic BP
- 55–70% of the systolic value (always below it)
- Heart rate
- 45–59 bpm (10%), 60–100 bpm (70%), 101–125 bpm (20%)
- Rhythm
- sinus 68%, af 25%, paced 7%
Kidney function and labs
- Age
- 18–39 years (5%), 40–64 years (30%), 65–79 years (45%), 80–90 years (20%)
- Sex
- female 50%, male 50%
- Baseline creatinine
- log-uniform between 0.6 and 4.5 mg/dL (spreads cases across all stages)
- Dialysis
- 5% of cases, creatinine 4–9 mg/dL
- Kidney transplant
- 5% of the remaining cases, creatinine 0.9–2.5 mg/dL
- Current creatinine
- AKI-range rise of 50%–200% over baseline in 12% of non-dialysis cases; a milder rise of 5%–40% in 20%; otherwise equal to baseline
- Potassium
- 3.2–3.7 mmol/L (8%), 3.8–5 mmol/L (72%), 5.1–5.5 mmol/L (12%), 5.6–6.4 mmol/L (8%)
- eGFR
- calculated by CKD-EPI 2021 from the age, sex and creatinine above (the override is left empty)
Medications
- No HF drugs
- 20% of cases are treatment-naïve
- HFrEF cases
- SGLT2 inhibitor 60%, MRA 50%, ACE-I/ARB/ARNI 75%, beta-blocker 75%, loop diuretic 45%, ivabradine 6%, digoxin or digitoxin 7%, vericiguat 4%, hydralazine/nitrate 3%, thiazide-type 5%, potassium binder 3%
- HFpEF cases
- SGLT2 inhibitor 40%, MRA 25%, ACE-I/ARB/ARNI 40%, beta-blocker 40%, loop diuretic 50%, others each at most 8%
- Choice within a class
- ACE-I/ARB/ARNI: ARNI 40%, ACE-I 25%, ARB 35%; MRA: spironolactone 50%, eplerenone 33%, finerenone 17%; other classes uniform. Nebivolol is only drawn in the ESC view.
- Dose
- 45% at the top dose step, otherwise uniform over the dose steps
- Loop diuretic daily dose
- furosemide 20–240 mg, bumetanide 0.5–5 mg, torsemide 5–40 mg per day
- At highest tolerated doses
- 50% yes; always yes when every drug is already at its top dose
More details
- Diabetes
- type 2 35%, type 1 3% (never both)
- BMI
- 19–42 kg/m²
- Prior lowest LVEF
- HFpEF cases only, 15% with a prior value of 15–40% (improved EF)
- Iron deficiency
- HFrEF cases: not checked 30%, present 30%, absent 40%
- QRS, LBBB, ischaemic aetiology, recent MI, pacing
- LVEF ≤35% cases only: QRS 80–180 ms; LBBB 35%; ischaemic 45%; MI in the last 40 days 3%; high RV pacing 5%; high-degree AV block 3%
- Months on optimal FMT
- LVEF ≤35% cases only, 0–36 months
- HF hospitalization in 12 months
- 30% when NYHA III or LVEF ≤35%
- Intolerances
- each of ACE-I angio-oedema, ACE-I cough, ARB, ARNI, beta-blocker and spironolactone-gynaecomastia 4%
- Guideline view
- not randomized: the ESC 2026 / ACC/AHA choice you made is kept