Millions of Americans with heart failure never receive the combination of medicines shown to keep them alive longer. Only 2 percent of eligible patients get the full four-pillar drug regimen, even though it can cut all-cause mortality by up to 60 percent.
A new Heart Failure Treatment Effect Calculator, presented at the European Society of Cardiology Congress and published August 31, 2026 in Nature Medicine, is designed to close that gap.
It gives doctors a personalized estimate of how a given patient's blood pressure, kidney function and potassium levels are likely to change on combination therapy.
Those three numbers are the exact reasons clinicians hesitate. "Fear of adverse effects, particularly low blood pressure, worsening kidney function or high potassium levels are the major reasons clinicians do not start treatment," said Dr. Nelson Wang, cardiologist and senior research fellow at The George Institute for Global Health, who led the work.
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How the calculator works
The tool draws on individual patient data from 38,753 people across nine major heart failure trials, with validation in 1,016 patients from four additional trials.
Using a patient's age, sex, BMI, baseline vitals and hospitalization history, it estimates the effect of five drug classes commonly used for heart failure, including ARNIs, SGLT2 inhibitors and mineralocorticoid receptor antagonists, taken alone or in combination.
The freely accessible tool sits at hfmodel.org.
What the numbers look like
Across the trial data, the recommended combinations produced only modest changes in blood pressure and early kidney function, along with small to moderate rises in potassium. In exchange, they cut the risk of worsening heart failure by 31 to 61 percent compared with standard care.
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That trade-off matters because heart failure, the condition where the heart cannot pump blood effectively, is common and deadly. Approximately 6.7 million American adults aged 20 and older have heart failure, and the condition contributed to 45 percent of cardiovascular deaths in the country in 2022.
Why so few patients get everything
The current standard, known as four-pillar therapy, combines a beta-blocker, an ARNI, an SGLT2 inhibitor and a mineralocorticoid receptor antagonist.
Guidelines call for starting these drugs together for patients with heart failure with reduced ejection fraction, meaning the heart's main pumping chamber is weakened. Real-world uptake sits at a small fraction of that.
Wang said the calculator can "reduce uncertainty and give clinicians greater confidence to prescribe these treatments simultaneously, ultimately helping more patients receive therapies that improve long-term outcomes."
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The authors note the calculator was built from clinical trial populations, so estimates may not fully generalize to the broader group of patients seen in everyday practice.
Patients who wonder whether their own regimen matches current guidelines should raise it with their doctor rather than adjust medications on their own.
The tool is live at hfmodel.org for any physician to use.
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This article is made and published by Jesper Bengtson, who may have used AI in the preparation.