Newly diagnosed heart failure with reduced ejection fraction: initiation of therapy
Write a prescription for heart failure with reduced ejection fraction (hfref) and have every line marked: drug choice, dose, route, frequency and duration, checked against the patient's allergies, current medicines, renal function and the interaction database, with each error explained.
hard8 scoring rules
- Patient
- 66 years, male, 85 kg
- Diagnosis
- Heart failure with reduced ejection fraction (HFrEF)
- Renal function
- eGFR 60 mL/min/1.73m²
- Allergies
- None known
- Current medicines
- atorvastatin 20 mg once daily; aspirin 75 mg once daily
The scenario
Patient B-217, a 66-year-old man, presents with a 2-week history of progressive breathlessness on exertion and ankle swelling. He is breathless after climbing 12 stairs and has gained 4 kg in weight. On examination, he is afebrile, heart rate 78 bpm, blood pressure 118/70 mmHg, respiratory rate 22/min, oxygen saturation 95% on room air. He has an elevated jugular venous pulse, bilateral basal crackles, and pitting oedema up to the mid-thigh. No heart murmurs are heard. His weight is 85 kg.
Investigations: full blood count, electrolytes, and renal function are within normal limits. Serum creatinine is 1.2 mg/dL, eGFR 60 mL/min/1.73m2. Potassium 4.2 mmol/L. Liver function tests and thyroid function tests are normal. Chest radiograph shows cardiomegaly and pulmonary vascular congestion. ECG shows sinus rhythm with left bundle branch block. An echocardiogram shows a dilated left ventricle with an ejection fraction of 30% and global hypokinesis. There is no significant valvular disease.
He has no known drug allergies. Current medications are atorvastatin 20 mg once daily and aspirin 75 mg once daily. He is a non-smoker.
Please write the prescription for the initial management of his heart failure. Specify the drugs, doses, and any monitoring you would order.
What gets marked
- Whether you chose an indicated drug, and whether you avoided the contraindicated ones.
- Dose, route, frequency and duration against the range for this patient.
- Renal and hepatic dose adjustment where this patient's numbers demand it.
- Allergy cross-reactivity and interactions with the medicines already on the chart.
- The instructions and monitoring you write, not only the drug you pick.
8 scoring rules apply to this scenario. A single critical error fails the attempt whatever the score.
Log in to prescribe for "Newly diagnosed heart failure with reduced ejection fraction: initiation of therapy"
A free account opens the prescription pad: search the formulary, write the chart, and have it marked line by line by the safety engine.
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Educational content for students and clinicians in training. It does not replace professional judgement, local protocols or current prescribing information.