Updated to create second cloze as previously discussed and original point of my suggestion was to break up the card. @Anking-maintainers this looks good. Can we get six votes and push? I understand it’s not everything everyone wants (me, @beejumm , and several maintainers on my original thread all wanted a main body mnemonic and this doesn’t have one). But this looks very improved from the original card, is more manageable with two clozes, and I think it should be merged
Has entresto been directly tested as HF survival benefit in a UWorld question or AMBOSS question?
I fully agree that it is important to include, but it can be in the extra if its not directly tested.
It’s a fair point. and no it’s not directly tested, but most of them aren’t either (I’ve only seen beta-blockers and MRAs)
Entresto is the first agent mentioned in the UW table and is highlighted in AMBOSS as the preferred RAAS inhibitor and one of the agents that improve survival. I am voting on keeping it in, as it will be helpful at least for the wards, if not for future questions
Just got a chance to look at the new suggestion - I think it overall looks a lot better and extra is very nicely organized. Going to make some small wording changes + re-order extra to match order of text field a bit better. Here are some notes:(a) Something reasonable that would be clinically helpful and also slightly consolidative would be to group these by GDMT pillar
- {{c1::ARNI > ACEi > ARB}}
- {c1::B-blocker}}
- {{c1::MRA}}
- {{c2::SGLT2i}}
(b) Even if we don’t include all the trial names, I would do something like this image to kinda tie everything together + include the specific meds not just classes
Personally I don’t think it’s worth adding another card to the deck by changing the last cloze to c2. Plus, there’s already a card that directly tests hydralazine+nitrates, which is what changing this to a c2 would effectively be doing. Having all as c1 makes it harder to memorize in the beginning, but these are all so HY that I think it’s worth it to keep all as c1.
I don’t think I saw the discussion about the rationale for breaking up the card, so maybe there’s a good argument to be made that I missed!
You basically got it right the rationale was just that it was too many things to remember. Since nid:1522787422448 and nid:1472611989012 already state that for African Americans have a mortality benefit for heart failure with left ventricular dysfunction with hydralazine and nitrates, I think we should get rid of that text from the main and just include it in extra. @Anking-maintainers thoughts?
I also switched the order of the stuff in the main to make it potentially easier to suggest a mnemonic later on if this suggestion gets approved
I’d at least keep Hydralazine/nitrates in Text, since we already have cards testing it it could just be unclozed. We’ll end up with multiple suggestions wanting to add it back otherwise.
@mohannadkh10 Reorganized some of the extra just to prioritize most relevant information at a glance:
β-blockers, MRAs, RAAS inhibitors (ACEIs/ARBs/ARNIs), and SGLT-2 inhibitors are part of Guideline-Directed Medical Therapy (GDMT) for heart failure (improve both survival and hospitalization rates)
SGLT-2 inhibitors are beneficial <u>regardless</u> of the presence or absence of diabetes (EMPEROR-Reduced trial)
GLP-1 receptor agonists (e.g., semaglutide) are not part of GDMT for HFrEF but provide cardiovascular benefits in patients <u>with</u> diabetes
Diuretics provide symptomatic relief for volume overload but no mortality benefit
Digoxin reduces hospitalizations but offers no mortality benefit
Don’t think we need the first bullet point if we add back Hydralazine/Nitrates in African Americans to the Text. Could even consider removing the bullet about SGLTi’s; that’s more of a fun fact than necessary for test-taking imo
That sounds good. Would you mind adding the hydralazine and nitrate bit back
Since the last close has been removed, I would prefer it to say" isosorbide dinitrate instead of nitrate
Stealing this image for lecture notes section! About to start IM and I can already tell these trial names will be talked about
@AnKing-Maintainers so what are we doing with this card? I like the current suggestion
Text is in a great place but think much of the extra can be shortened/is unnecessary for our purposes:
GDMT bullet point 
(solely for the reason you will likely be asked about it on rounds).
Hydralazine/nitrate bullet 
(just restating text with unneeded minutiae).
SGLTi bullet though would still advocate shortening as I suggested above (glucose pee drug can be used outside of diabetes, important distinction imo).
Combine these two bullets: “Diuretics provide symptomatic relief and digoxin reduces hospitalizations, but neither provide mortality benefit”. … .
GLP1 bullet I think we can go with or without, is this tested?
Hate to be that guy, but I kinda think that hydral/nitrates should still be clozed 
I think Cameron makes some good points. @mohannadkh10, are you on board with making these changes (since it’s your suggestion)?
@herstein.jacob, I too share the primordial urge to preserve existing clozes ! However, I echo others in saying that it’s not necessary to keep, given the existing notes (nid:1522787422448,1472611989012) on the topic. But I’m willing to compromise if it means finally pushing this suggestion haha
Agree with @herstein.jacob, its nice to have it all in one place on one card and clozed, or we can make it a c2?
I remember this concept came up on slack quite awhile ago when we were discussing cards that cover multiple concepts and individual ones and if we should keep both vs delete dupes.
I feel like I remember the consensus being that we keep both because recalling things individually and recalling them in groups is not a true “dupe”.
@Ahmed7 did this get put in the maintainer handbook or anything like that?