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 do I use the SHARE-HF decision aid?

3. Why choose the LIFE-HF model over other clinical prediction models (risk calculators)?

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

5. Where do the estimates of benefits and harms come from?

6. How were costs estimated? (last updated _)

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

The SHARE-HF decision aid is an interactive decision aid that gives individualized estimates of life expectancy, 5-year survival, and 5-year “event-free survival” for patients with heart failure (HF) with reduced ejection fraction (HFrEF). It shows the impact of different medication options for HFrEF on these outcomes, along with estimates of side-effects, costs, and other considerations. Simply put, it provides all the information needed by patients and their clinicians to make a shared decision about their HFrEF medications.

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

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

Step 1: Select display option

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

Individualize: This option allows you to calculate a patient’s individualized risks 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 “1. Estimate the patient’s risk” title to collapse this section and move onto the next step.

Population-level numbers: This option skips the individual patient risk calculator and gives population-level risks without treatment.

No numbers: This option removes numerical and graphical estimates of risks and treatment benefits. It is intended for patients who wish not to see this information regarding their prognosis.

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

This section focuses on the main consequences of HFrEF: Survival, hospitalizations, and quality of life (QoL). You can toggle between showing the numbers and “smiley face” icon array for life expectancy/5-year survival, or the composite of death or HF hospitalization. When no treatment selected in Step 3, this shows the risks to the patient with current treatment or no HFrEF medications (depending on what is selected in Step 1). When a treatment is selected in Step 3, this section dynamically updates to show the risks with current/no treatment and with the selected medication regimen or individual medication, along with the differences.

Step 3: Treatment options

First, select whether you want to see typical medication regimens (combinations of HFrEF medications) or specific medications. The “typical medication regimens” options lets you quickly select from a few 3- or 4-medication regimens currently recommended by HF guidelines. Any medications that the patient is already taking (as selected in Step 1, individualize) are marked in green and pre-selected. Selecting an option will dynamically update Step 2 to show the benefits of that option on life expectancy/survival, HF hospitalizations, and QoL.

Clicking the down arrow on the option button will expand the button to show the regimen/medication’s possible side-effects (and probability), monthly cost, and 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 given to the patient.

EMR Note/Share Link

The “EMR Note/Share Link” button creates a template note that can be copied and pasted into an EMR, and then edited as needed. It also provides a sharable link for future reference with all of the inputs currently selected in the decision aid.

3. Why choose the LIFE-HF model over other clinical prediction models (risk calculators)?

Many clinical prediction models (also known as "risk scores" or "risk calculators") have been developed 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 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 use of Web of Science’s "cited reference search" for systematic reviews and validation studies. We considered any risk score for inclusion if they met the following criteria:

1. Evaluated outcomes of all-cause mortality/survival, all-cause hospitalizations, 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; and

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.

Based on these criteria, we initially selected the MAGGIC and the BCN Bio-HF calculator, which we implemented in an early prototype. In an updated search, we simplified the decision aid by removing these models and replacing them with the LIFE-HF model. LIFE-HF includes several routinely-collected variables, many of which were included in the previous risk scores, including NT-proBNP, which is the strongest 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 further validation is ongoing 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 for patient risk communication, while also predicting 5-year risk of death or HF hospitalization.

4. 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 of all intervention selected. For side-effects, adverse events that were statistically significantly higher with therapy in RCTs are reported as absolute risk increases.

5. How were costs estimated? (last updated 6 February 2025)

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/
• http://www.medi-mouse.com/drugfind.php
• https://www.studybuffalo.com/tools/drug-price-calculator/

Decision aid developed by: SHARE-HF study team led by Ricky Turgeon BSc(Pharm), ACPR, PharmD.

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

Current version: Version 0.1 (last update: 6 February 2025)

Last evidence review: 6 February 2025