SHARE-HF Decision Aid: Frequently Asked Questions (FAQ)

The SHARE-HF decision aid was developed as part of the SHARE-HF research program.

Contents of this FAQ:

1. What does the SHARE-HF decision aid do?

2. How does SHARE-HF fit into patient care?

3. How do I use the SHARE-HF decision aid?

4. What does SHARE-HF use to provide individualized predictions?

5. What do I do if my patient is “out of range” for one or more variables in Step 1?

6. How were costs estimated? (last updated 2025-07-02)

7. Disclosures & version history

1. What does the SHARE-HF decision aid do?

SHARE-HF is a web-based, interactive decision aid for the medication management of heart failure (HF) with reduced ejection fraction (HFrEF) that: (1) provides individualized prognosis; (2) presents evidence-based medication options; and (3) quantifies benefits and downsides across 6 patient-prioritized treatment features (survival, quality of life, HF hospitalization, cost, side-effects, and pill burden). Simply put, it provides all the information needed by patients and their clinicians to make a shared decision about medications to treat HFrEF.

This decision aid is not currently intended for use in people with other forms of HF, such as HF with mildly-reduced (HFmrEF) or preserved ejection fraction (HFpEF).

2. How does SHARE-HF fit into patient care?

We designed SHARE-HF to fit with the Agency for Healthcare Research Quality’s SHARE (Seek, Help, Assess, Reach, Evaluate) approach. The stepwise approach is illustrated in the figure below:

3. How do I use the SHARE-HF decision aid?

Although SHARE-HF works on any device, it looks best on a screen 15” or larger in landscape (horizontal) view.

Step 1: Choose display

The SHARE-HF decision aid can be as individualized or simple as you need. The first step is to select the display option:

Individualized predictions: This option allows you to calculate a patient’s individualized 5-year survival and life expectancy based on patient-specific clinical data, including current HFrEF medications. The calculator automatically updates the risk based on your inputs. Once done entering the data, you can press the “Estimate patient risk” title to collapse this section and move onto the next step.

Population-level estimates: This option skips the individual patient risk calculator and gives a broad estimate of risk based on untreated patients with HFrEF.

Step 2: Know the risks of heart failure / Know the benefits & harms of treatment

This section focuses on the main impacts of HFrEF: Survival (communicated using both 5-year survival probability and life expectancy), HF hospitalizations, and quality of life (QoL). If “individualized predictions” was selected in step 1, survival numbers are tailored to that person’s individual risk based on the LIFE-HF model.

• When no additional medications are selected in Step 3: Displays the patient’s risk with current or no HFrEF medications and serves as an educational tool.

• When additional medications are selected in Step 3: Dynamically updates to show the risks with the selected additional medications versus the medication regimen selected under Step 1 (i.e., versus no HFrEF medications if none selected in Step 1).

Step 3: Treatment options

First, select whether you want to see typical medication regimens, or specific medications. The “What are typical medication combinations?” option lets you quickly select from 3- or 4-medication combinations currently recommended by HF guidelines. Any medications that the patient is already taking (as selected in Step 1, individualize) are marked in blue as “already taking”. Selecting an option will dynamically update the information in “2. Know the benefits & harms of treatment”.

Clicking the down arrow on the right side of a medication button will expand the button to show the regimen/medication’s possible side-effects (along with their risk increase versus placebo), monthly cost in $CAD, and medication administration routine.

Print

Press the print button to use your web browser’s print function to print a copy of the decision aid on a single page in landscape orientation, which can be shared with patients.

EMR Note/Share Link

The “EMR Note/Share Link” button creates a template note that can be copied and pasted into any EMR, and then edited as needed. It also provides a sharable link to the current page (with information filled in for step 1 and options selected in step 3.

4. What does SHARE-HF use to provide individualized predictions?

SHARE-HF uses the LIFE-HF model. LIFE-HF includes several routinely-collected variables, many of which were included in the previous risk scores, as well as NT-proBNP, which is the strongest individual predictor of death and HF hospitalizations in patients with HFrEF. The LIFE-HF has also been validated with good predictive performance (including discrimination and calibration) in multiple clinical trials and international registries, and in an independent North American validation study by our group. Importantly, the LIFE-HF model is the only HF risk model that presents risk of death as both estimated life expectancy and 5-year survival, which offers flexibility in communicating medication benefits to patients.

Many clinical prediction models (also known as "risk scores" or "risk calculators") exist to predict outcomes in people with HF, each with their own strengths and limitations. To identify the best risk scores to use in our decision aid, we initially performed a comprehensive search, including a review of HF guidelines (Ezekowitz 2017, O'Meara 2020, Yancy 2013, Yancy 2017, Ponikowski 2016), and tertiary references (Dynamed, UpToDate), consultation with HF experts, supplemented with a search of PubMed (initially in July 2019 and last updated February 2025) and Web of Science’s "cited reference search" for systematic reviews and validation studies. The quality criteria that we considered in selecting a risk score for SHARE-HF:

1. Evaluated outcomes of death and/or HF hospitalizations at a timepoint of ≥1 year;

2. Incorporated variables that are readily measured and available in clinical practice;

3. Included ambulatory patients with HFrEF;

4. Had been externally validated in ≥1 study;

5. Demonstrated good predictive power, as indicated by at least "fair" model discrimination (e.g. c-statistic ≥0.70) with good calibration in external validation; and

6. In 2025, we added the criterion that survival would ideally be conveyed using both 5-year probability and life expectancy.

5. What do I do if my patient is “out of range” for one or more variables in Step 1?

SHARE-HF uses 5 numerical variables in Step 1 to estimate survival: Age, systolic blood pressure (BP), NT-proBNP, ejection fraction, and eGFR. The range of accepted values is based on the original sample of patients used to develop the LIFE-HF model. How “out of range” values are handled depends on the variable and value.

1. Age: SHARE-HF accepts age values in the range of 40 to 85 years; higher age predicts lower survival. For patients ±5 years outside this range, it would be reasonable to calculate their risk as if their age were in range, with the caveat that their risk may be lower/higher. For example, estimate a 35 year old patient’s prognosis the lower limit of the age range (40), and note that their prognosis may be slightly more optimistic than this.

2. Systolic BP: SHARE-HF accepts systolic BP values between 99 and 175 mm Hg; lower systolic BP predicts lower survival. The same principle as age applies here, with the caveat that systolic BP <100 also signals lower chance of being able to tolerate target doses of HFrEF medications.

3. NT-proBNP: SHARE-HF accepts NT-proBNP values between 99 and 16,440 ng/L; higher values predict lower survival.

   • Values >16,440 ng/L are generally seen only in patients with acute HF (usually hospitalized) or outpatients with end-stage renal disease. If the latest NT-proBNP was taken during an acute HF episode or hospital admission, consider repeating as an outpatient to get a value that reflects their current state as an outpatient.

   • For patients with NT-proBNP values <99 ng/L, it is reasonable to calculate their risk with the value set at 99.

4. Ejection fraction: SHARE-HF accepts ejection fraction values between 13 and 40%; lower ejection fraction predicts lower survival. SHARE-HF should only be used in patients with HFrEF whose latest ejection fraction is 40% or less. For patients with ejection fraction <13%, it is reasonable to calculate their risk with the value set at 13%, acknowledging that their prognosis is likely lower than the estimate provided. This estimate can then be updated with changes to ejection fraction changes with treatment.

5. eGFR: SHARE-HF accepts eGFR values between 34 and 130; both lower and higher eGFR predict survival (U-shaped association). For patients with eGFR <34, it is reasonable to calculate their risk with the value set at 34 for the purpose of estimating prognosis, with the caveat that evidence for the efficacy of HFrEF medications is more limited at eGFR <30, and some agents appear ineffective at eGFR <20-30.

6. How were medication options chosen and where do the estimates of benefits and harms come from?

We selected medication options to present in this decision aid based on a comprehensive review of guidelines and reviews on HFrEF, as well as consultation with heart failure experts. The current version of the decision aid includes only medications that prolong survival in patients with HFrEF (other medications - such as ivabradine, digoxin, vericiguat - are not currently included). The estimates of benefits and side-effects come from randomized controlled trials (RCTs) and meta-analyses of RCTs, described in the table below. A patient’s individualized benefit is estimated by applying the cumulative relative risk reduction (RRR) of all intervention selected. For mortality, the LIFE-HF model estimates death from cardiovascular and non-cardiovascular causes separately, then combines them to provide an estimate of death from any cause. Since HF medications do not affect non-cardiovascular death, we apply the additive RRR from all medications to the LIFE-HF model estimate of cardiovascular death, then combine with non-cardiovascular death to provide an estimate of all-cause death on treatment. For side-effects, adverse events that were statistically significantly higher with therapy in RCTs are reported as absolute risk increases.

7. How were costs estimated? (last updated 2026 June 22)

Cost estimates are based on Canadian dollars (CAD), updated annually or more frequently as needed, and estimated using the following websites:

• https://pricingdoc.acfp.ca/

• https://pharmacareformularysearch.gov.bc.ca/

• http://www.medi-mouse.com/drugfind.php

8. Disclosures & version history

Decision aid developed by: SHARE-HF study team led by Ricky Turgeon BSc(Pharm), ACPR, PharmD. Dr. Turgeon has no financial conflict of interest (including no conflict of interest with any pharmaceutical or medical device manufacturer).

Programmed by: Blair MacDonald BA, PharmD, PhD Student, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC

Current version: Version 1.0 (last update: 2026-03-30)

• v1.0 update (2026-03-30):

  • Added more languages (traditional Chinese, Spanish, Tagalog) and changed to allow persistent inputs across languages (e.g., allowing an English-only speaker to input steps 1-3, then switch to other language for patients to review).

  • Updated costs to reflect the following:

    • 100% coverage of SGLT2 inhibitors (dapagliflozin and empagliflozin) via National PharmaCare in certain provinces (e.g., BC as of 2026-03-01).

    • Addition of generic form of sacubitril-valsartan to the Canadian Market as of late 2025.

    • Changes to EMR notes for clarity.

Last evidence review: 2026-06-22