Bram Pemberly

Active medications
Medication	Dose and directions	Type	Status	Started	Prescriber
Loratadine	10 mg tablet · 1 by mouth daily as needed	Home medication	Active	2021-06-27	Dr. Imogen Vale
Melatonin	3 mg tablet · 1 by mouth at bedtime as needed	Home medication	Active	2024-07-27	Dr. Imogen Vale
Acetaminophen	500 mg tablet · 1–2 by mouth every 6 hours as needed	Home medication	Active	2021-05-20	Dr. Imogen Vale

Specificity How to read this

“Draft · pending review” means the definition awaits approval by your clinical and coding reviewers.

Not assessable: your judgement Heart pumping fraction (ejection fraction, EF) Draft · pending review

The note says HFrEF; the echocardiogram report on file states no left-ventricular ejection fraction, so the type cannot be checked.

Note read by: AI reader and rule reader agree · AI reader quoted HFrEF

Evidence from the record (1)

Echocardiogram report 2026-10-13 (transthoracic, right-heart study, report text only): the report text states no left-ventricular ejection fraction (Dr. Ines Varga (cardiology))

Show in the note Reports

Options

Choose wording yourself, or none. Nothing is pre-selected; the list and its order are the same for every patient.

Met / not met only says whether the recorded value falls inside that definition's range. It is not a recommendation; the diagnosis is your judgement.

Needs: latest ejection fraction 40% or lower Record: no ejection fraction on file · ∅ not assessable
Needs: latest ejection fraction 41% to 49% Record: no ejection fraction on file · ∅ not assessable
Needs: latest ejection fraction 50% or higher Record: no ejection fraction on file · ∅ not assessable
Needs: an earlier ejection fraction of 40% or lower, the latest above 40%, and a rise of at least 10 points Record: no ejection fraction on file · ∅ not assessable

One click places the wording you choose in the unsigned draft as a new line at the end of the assessment (your existing wording is not changed), highlighted, for you to edit or undo before signing. Your choice and the evidence shown are recorded.

Provenance

This check is stored and can be re-run to the same result.
Inputs: 1 record item, listed under Evidence above.
Readers: AI reader and rule reader agree
What happened so far: No response yet · shown 1 time before on this visit
Offer OF-000045 in the provenance record

Reference ids (for audit)

Definition version front_hf_ef_type@1.0 · run FRUN-00051 · replay e089013f4263…
Input ids: ECHO-P43-1

Who read the note

Rule reader: a fixed word list, always on.
AI reader: openrouter · openai/gpt-6.1-terra. It may only quote the note; its quotes are checked character by character and must agree with the rule reader.
The results side (values, dates, definition) never depends on either reader.

Reference ids (for audit)

Rule reader word list: front-lexicon 1.0
AI reader: openrouter · openai/gpt-6.1-terra, version openai/gpt-6.1-terra; task exactdx.front_statements@1

Published definition and source

Clinical implications of the universal definition for the prevention and treatment of heart failure

definition version 1.0

Chandramouli C, Stewart S, Almahmeed W, Lam CSP (Clinical Cardiology) · 2022 · Section 1.3 'New universal definition' (classification by left ventricular ejection fraction) · source

Licence: open licence (Creative Commons Attribution 4.0), attribution: Chandramouli C, Stewart S, Almahmeed W, Lam CSP. Clinical implications of the universal definition for the prevention and treatment of heart failure. Clin Cardiol 2022;45(Suppl 1):S2-S12. doi:10.1002/clc.23842. Licensed under CC BY 4.0.. Source checked: opened (2026-11-14).

Categories by ejection fraction: 40% or lower; 41% to 49%; 50% or higher; improved (earlier 40% or lower, now above 40%, a rise of at least 10 points). Acuity is a clinical judgement: indicators are shown, nothing is concluded.

Edition note: The 2021 categories are shown as the 2021 edition. A 2026 second universal definition reportedly drops fixed cut-offs between reduced and preserved ejection fraction while keeping the improved category (summary of an openly licensed editorial; the consensus document itself was not opened). Clinical decision needed before release.

Edition note: A federal cross-check (NHLBI, 2022) describes reduced ejection fraction as below 40%, not 40% or lower: the boundary at exactly 40% differs between sources.

See also: Universal definition and classification of heart failure (2021); Second universal definition of heart failure (2026); Accelerating heart failure research (2022); ICD-10-CM FY2027 tabular list and index (2026).

Draft definition: pending clinical and coding review. No endorsement by the cited bodies is implied.

Reference ids (for audit)

Definition key front_hf_ef_type@1.0

Relevant history

Type at least three letters of the reason for visit to list related items from the whole chart.

Other checks 1

Other measurements checked against published definitions (the extended set).

Agrees: nothing to do Kidney filtering rate (eGFR) over time

Kidney results 200 days apart are 60 or above (filtering rate 82.6 on 2026-04-26 and 82.6 on 2026-11-12) and the note doesn't mention kidney function.

Show the results

Details

Thresholds

Heart pumping fraction (ejection fraction, EF): Categories by ejection fraction: 40% or lower; 41% to 49%; 50% or higher; improved (earlier 40% or lower, now above 40%, a rise of at least 10 points). Acuity is a clinical judgement: indicators are shown, nothing is concluded.

Rules and published sources

ckd_epi_2009@1.0 Levey et al., Ann Intern Med 2009;150:604-12 (2009 eGFR equation, drift check) · source
ckd_epi_2021@1.0 Inker et al., N Engl J Med 2021;385:1737-49 (2021 race-free eGFR equation) · source
kdigo_aki_2012@1.1 KDIGO 2012 guideline, Kidney Int Suppl 2012;2:1-138 (Rec 2.1.1-2.1.2, Table 2) · source
kdigo_ckd_2024@1.1 KDIGO 2024 guideline, Kidney Int 2024;105(4S):S117-S314 (G/A categories, >3 months) · source
kidney_compare@1.1 this tool's comparison rules (both directions) · source
kidney_exclusions@1.0 KDIGO 2024 guideline, limitations of creatinine-based eGFR (muscle mass, pregnancy, kidney replacement); local list · source
lab_units@1.1 KDIGO 2012 and 2024 guidelines, unit conversion (creatinine 1 mg/dL = 88.4 umol/L; ACR 1 mg/mmol = 8.84 mg/g) · source
front_hf_ef_type@1.0 draft, pending review

Record

Check RUN-00051 · kidney-engine 2.0 · replay 5423f449dd7c…. Data for this panel (JSON).

Specificity check FRUN-00051 · front-engine 1.2 · replay e089013f4263….

Library check LRUN-00051 · library_default_set@1.1 · library-engine 1.1 · replay 3a584d2d11b6….

Decision support only: you decide and you write the note. Nothing is inserted unless you click it. DataCrafters 1.0.0 · data as of Fri Nov 13, 2026 04:55 PM

Active medications