Clinician reference tool — not medical advice. This is a clinical decision-aid intended for healthcare professionals: it gives deterministic suggestions to think with, not a diagnosis or a prescription. If you’re a patient, you’re welcome to look around — but please review anything here with your own doctor; it isn’t a substitute for personalized medical care.

Evidence: Taylor AL 2049 · sources last checked 2026-08-20

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Ajax Harwood Clinic
Heart-failure GDMT selector
Reference tool — not medical advice. Deterministic suggestions to think with, grounded in current CCS/CHFS heart-failure guidelines and pivotal trials; clinician judgement, current product monographs, and live ODB coverage always required. Runs entirely in your browser — no data is collected.

Heart-failure GDMT selector

Choose the HF phenotype and the patient’s characteristics to get ranked, guideline-directed medical therapy suggestions across the LVEF spectrum — the four foundational pillars plus the right add-ons, with the CCS/CHFS guideline and trial reasoning and references behind each.

Patient characteristics

HF phenotype

Congestion & status

Comorbidities

Practical & tolerability

Contraindications & cautions

Gating is per drug class — e.g. angioedema removes the ARNI/ACE inhibitor but leaves the other pillars.

Start by choosing the HF phenotype.

e.g. HFrEF to see the four foundational pillars, or HFpEF + Obesity to see how the ranking shifts to SGLT2i, finerenone and semaglutide.

References

  1. [1]McDonald M, et al. CCS/CHFS Heart Failure Guidelines Update: Defining a New Pharmacologic Standard of Care for Heart Failure With Reduced Ejection Fraction (the four foundational pillars). Can J Cardiol 2021;37(4):531-546. link
  2. [2]Canadian Cardiovascular Society/Canadian Heart Failure Society 2025 Guideline Update for Pharmacologic Management of Heart Failure With Nonreduced Ejection Fraction (LVEF >40%). Can J Cardiol 2025. link
  3. [3]CCS-CHFS Focused Clinical Practice Update of Patients With Differing Heart Failure Phenotypes. Can J Cardiol 2023. link
  4. [4]McMurray JJV, et al. PARADIGM-HF: Angiotensin–neprilysin inhibition (sacubitril/valsartan) versus enalapril in HFrEF. NEJM 2014;371:993. link
  5. [5]SOLVD Investigators. Effect of enalapril on survival in patients with reduced LV ejection fractions and heart failure. NEJM 1991;325:293. link
  6. [6]Granger CB, et al. CHARM-Alternative: Candesartan in HFrEF patients intolerant of ACE inhibitors. Lancet 2003;362:772. link
  7. [7]CIBIS-II (bisoprolol, Lancet 1999), MERIT-HF (metoprolol succinate, Lancet 1999) and COPERNICUS (carvedilol, NEJM 2001): beta-blocker mortality benefit in HFrEF. link
  8. [8]Pitt B, et al. RALES: Spironolactone in severe heart failure. NEJM 1999;341:709. link
  9. [9]Zannad F, et al. EMPHASIS-HF: Eplerenone in mild HFrEF. NEJM 2011;364:11. link
  10. [10]McMurray JJV, et al. DAPA-HF: Dapagliflozin in HFrEF (with and without diabetes). NEJM 2019;381:1995. link
  11. [11]Packer M, et al. EMPEROR-Reduced: Empagliflozin in HFrEF. NEJM 2020;383:1413. link
  12. [12]Solomon SD, et al. DELIVER: Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction. NEJM 2022;387:1089. link
  13. [13]Anker SD, et al. EMPEROR-Preserved: Empagliflozin in heart failure with preserved ejection fraction. NEJM 2021;385:1451. link
  14. [14]Solomon SD, et al. FINEARTS-HF: Finerenone in heart failure with mildly reduced or preserved ejection fraction. NEJM 2024;391:1475. link
  15. [15]Taylor AL, et al. A-HeFT: Fixed-dose isosorbide dinitrate + hydralazine in self-identified Black patients with HFrEF. NEJM 2004;351:2049. link
  16. [16]Swedberg K, et al. SHIFT: Ivabradine in HFrEF, sinus rhythm, HR ≥70 despite beta-blockade. Lancet 2010;376:875. link
  17. [17]Armstrong PW, et al. VICTORIA: Vericiguat in HFrEF with a recent worsening-HF event. NEJM 2020;382:1883. link
  18. [18]Digitalis Investigation Group. DIG: Effect of digoxin on mortality and hospitalization in heart failure. NEJM 1997;336:525. link
  19. [19]Kosiborod MN, et al. STEP-HFpEF: Semaglutide 2.4 mg in heart failure with preserved ejection fraction and obesity. NEJM 2023;389:1069. link
  20. [20]Health Canada — Drug Product Database & product monographs (Entresto, Forxiga, Jardiance, Kerendia, Lancora, Verquvo, and the generic ACEi/ARB/beta-blocker/MRA/loop agents). link
  21. [21]Ontario Drug Benefit (ODB) e-Formulary — coverage/Limited-Use criteria for HF agents; weight-management (semaglutide) use is not publicly covered. Check live before counselling on coverage. link