QUAD Score Calculator

Heart Failure with Reduced Ejection Fraction (HFrEF) Therapeutic Score

No drug: 0
|
Dose <50%: 1
|
Dose ≥50%: 4
|
Exempt: e

Excellent (15-24)

(4+4+4+4)+8 = 24
4 medication classes at ≥50% dose (Sacubitril Valsartan 200mg, Bisoprolol 10mg, Eplerenone 50mg, Dapagliflozin 10mg)
(4+1+1+1)+8 = 15
1 medication class at ≥50% and 3 at <50% dose (Dapagliflozin 10mg, Sacubitril Valsartan 50mg, Bisoprolol 2.5mg, Eplerenone 12.5mg)

Good (8-14)

(4+4+4) = 12
3 medication classes at ≥50% dose (Sacubitril Valsartan 100mg, Bisoprolol 5mg, Eplerenone 25mg)
(4+4) = 8
2 medication classes at ≥50% dose

Poor (<8)

(1+1+1) = 3
3 medication classes at <50% dose (Sacubitril Valsartan 50mg, Bisoprolol 1.25mg, Eplerenone 12.5mg)
4
1 medication class at ≥50% dose (Dapagliflozin 10mg)
Exemption Note: An 'e' is added to the score to mark an exemption or variance in medication class use. For example, if a patient is on ≥50% doses of 3 medication classes but has a clinical reason they are exempt from an MRA, they would be scored a 12e, with appropriate documentation in the clinical notes.
Definitions
Dose
Percentage of maximum guideline recommended HFrEF dose of drug
Weight
Premium score added if all four foundational medication classes prescribed - 8
QUAD Score Interpretation
Poor <8, Good 8-14, Excellent 15-24
Abbreviations
HFrEF
Heart Failure with a Reduced Ejection Fraction
ACEi
Angiotensin Converting Enzyme inhibitor
ARNI
Angiotensin Receptor, Neprilysin Inhibitor
AIIRB
Angiotensin II Receptor blocker
BB
Betablocker
MRA
Mineralocorticoid Receptor Antagonist
SGLT2i
Sodium Glucose Co-transporter II Inhibitor
N/A
Total Score
0
Category
Reference: Savage HO, Dungu JN, Dimarco A, et al. A novel treatment score (QUAD score) to promote treatment optimization in heart failure with a reduced ejection fraction. ESC Heart Fail. 2025;12(6):4150-4159. doi:10.1002/ehf2.15407