Heart health · For patients and doctors
Tick your symptoms and conditions, and add your NT-proBNP and echo result if you have them. You get your stage, what the blood test means at your age, which test comes next and how soon, and a daily plan if you have heart failure. Doctors get the full clinical view: the cut-off for this patient, the type by ejection fraction, two risk scores, and what each medicine should do at this blood pressure, potassium and eGFR.
A calculator, not a diagnosis. Heart failure is diagnosed by a doctor from your symptoms, an examination, a blood test and an echocardiogram. If you are breathless at rest, have chest pain or have fainted, call 108 now. Nothing you enter leaves this page.
Heart failure medicines, by group. Look for the generic name on the strip.
Medicines that can worsen heart failure.
Generic names. Rows needing a change or caution on the values entered are highlighted. Class and level are from the 2026 ESC guideline unless marked. Check the current label before prescribing.
| Therapy | For this patient | Rule |
|---|
| Medicine | Start | Target |
|---|---|---|
| Sacubitril-valsartan | 49/51 mg twice daily (24/26 mg if eGFR 30–60, no previous ACE inhibitor, or a history of symptomatic hypotension) | 97/103 mg twice daily |
| Enalapril | 2.5 mg twice daily | 10–20 mg twice daily |
| Ramipril | 1.25–2.5 mg twice daily | 5 mg twice daily |
| Lisinopril | 2.5–5 mg once daily | 20–35 mg once daily |
| Losartan | 25–50 mg once daily (12.5 mg if needed) | 150 mg once daily |
| Valsartan | 40 mg twice daily | 160 mg twice daily |
| Candesartan | 4 mg once daily | 32 mg once daily |
| Bisoprolol | 1.25 mg once daily | 10 mg once daily |
| Carvedilol | 3.125 mg twice daily | 25 mg twice daily (50 mg twice daily if over 85 kg) |
| Metoprolol succinate (CR/XL) | 12.5–25 mg once daily | 200 mg once daily |
| Nebivolol | 1.25 mg once daily | 10 mg once daily (not shown to reduce death in heart failure) |
| Spironolactone | 12.5–25 mg once daily | 50 mg once daily |
| Eplerenone | 25 mg once daily | 50 mg once daily |
| Finerenone (LVEF 50% or above) | 10 mg once daily if eGFR 60 or below; 20 mg if above 60 | 20 mg if eGFR 60 or below; 40 mg if above 60 |
| Dapagliflozin, empagliflozin | 10 mg once daily | 10 mg once daily |
| Ivabradine | 5 mg twice daily | 7.5 mg twice daily |
| Vericiguat | 2.5 mg once daily | 10 mg once daily |
| Digoxin | 62.5 micrograms once daily | 250 micrograms once daily, titrated to plasma level |
| Hydralazine with isosorbide dinitrate | 37.5 mg with 20 mg, three times daily | 75 mg with 40 mg, three times daily |
Increase at least every 1 to 2 weeks, guided by symptoms, blood pressure, pulse, potassium and creatinine (ESC 2026, class I). After a hospital admission, start and increase quickly with close review in the first 6 weeks: in STRONG-HF this cut death or readmission at 180 days from 23.3% to 15.2%.
| Medicine | In this patient | Evidence |
|---|
In the National Heart Failure Registry of India (10,851 patients) the mean age was 59.9 years, about ten years younger than in registries from high-income countries. Ischaemic heart disease was the cause in 72%. Only 47.5% of patients with reduced ejection fraction were receiving guideline-directed therapy, and 14.2% had died by 90 days. The NT-proBNP cut-offs and both risk scores on this page were derived in European and North American cohorts.
Heart failure does not mean the heart has stopped or is about to stop. It means the heart cannot pump enough blood, or can do so only at high pressure. Fluid then collects in the lungs and legs, which causes breathlessness and swelling. It is a long-term condition, and it is treatable: the right medicines improve symptoms, keep people out of hospital and lengthen life.
They are hormones released by the heart muscle when it is stretched or under strain. A low level makes heart failure very unlikely, which is why the test is done first. A raised level does not prove heart failure: age, kidney disease, atrial fibrillation and lung disease also raise it, and obesity lowers it. That is why the cut-off on this page changes with your age, weight, rhythm and kidney function, and why an echocardiogram is the next step.
LVEF (left ventricular ejection fraction) is the share of blood the main pumping chamber pushes out with each beat, measured on an echocardiogram. It is normally 50% or more. Below 50% the pump is weak (heart failure with reduced ejection fraction). Heart failure can also occur with a normal LVEF, when the heart is stiff and fills poorly (preserved ejection fraction). This is common in older people and in those with diabetes, high blood pressure or obesity.
Stage A: at risk, no heart damage and no symptoms. Stage B: a change in the heart or a raised blood test, but no symptoms yet. Stage C: heart failure with symptoms, now or in the past. Stage D: advanced heart failure. The stages only move forward, which is why finding stage A and B early matters.
People with diabetes develop heart failure more often, and it can be the first heart complication, before any heart attack. It is often missed because breathlessness is put down to weight or age. The American Diabetes Association advises considering an NT-proBNP or BNP test in adults with diabetes, and an echocardiogram if it is raised. Some diabetes medicines protect against heart failure and a few make it worse, so the choice of diabetes medicine changes once heart failure is found.
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