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First-line treatment for HFrEF in a 65-year-old with diabetes?
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Per ESC 2023 HF Guidelines, initiate four-pillar therapy simultaneously at low doses:

  1. 1.ARNI (sacubitril/valsartan) — preferred over ACE-I (Class I, Level B)
  2. 2.Beta-blocker — bisoprolol, carvedilol, or metoprolol succinate
  3. 3.MRA — eplerenone preferred over spironolactone with diabetes
  4. 4.SGLT2-i — dapagliflozin or empagliflozin (dual HF + T2DM benefit)
📋 ESC HF Guidelines 2023🔬 DAPA-HF (NEJM 2019)🔬 EMPEROR-Reduced (NEJM 2020)

Every Query Searches 8 Authoritative Sources.

Prognia doesn't pick one source — it searches all of them and synthesises a coherent, cited answer.

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PubMed

35M+ peer-reviewed papers

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ESC Guidelines

European Society of Cardiology

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AHA/ACC

American Heart Association

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NICE

National Institute for Health and Care Excellence

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ADA Standards

American Diabetes Association

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GOLD

Global Initiative for COPD

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EULAR

European Rheumatology guidelines

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Clinical Cases

Curated real-world case database

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