, hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia, Chagas disease, restrictive cardiomyopathy, cardiac sarcoidosis, amyloid, aortic stenosis) 5. Annual review needed for patients with established advanced HF in which patients/caregivers and clinicians discuss current and potential therapies for both anticipated and unanticipated events, possible HF disease trajectory and prognosis, patient preferences, and advanced care planning 6. Assessment of patient for possible participation in a clinical trial ACEI angiotensin converting enzyme inhibitors; ARB angiotensin receptor blockers; ARNI angiotensin receptor-neprilysin inhibitor; BNP B-type natriuretic peptide; BUN blood, urea, nitrogen; CRT cardiac resynchronization therapy; EF ejection fraction; GDMT guideline-directed medical therapy; HF heart failure; ICD implantable cardioverter- de brillator; LVEF left ventricular ejection fraction; NT-proBNP N-terminal pro-B-type natriuretic peptide; NYHA New York Heart Association; SGLT2 sodium-glucose cotransporter-2. J Maddox et al. symptoms (60), the reassessment of BNP or NT-proBNP may be informative. Severe renal dysfunction may inter- fere with the interpretation of natriuretic peptide con- centrations. Importantly, current evidence does not suggest targeting treatment to speci c BNP or NT-proBNP levels. Although rising natriuretic peptide concentrations are correlated with adverse outcomes, this relationship can be confounded by the use of sacubitril/valsartan. Due to neprilysin inhibition, concentrations of BNP sometimes modestly rise in patients treated with sacubitril/valsartan and tend not to rapidly return to baseline despite chronic therapy. In contrast, NT-proBNP concentrations typically decrease much more consistently than do BNP concen- trations, as NT-proBNP is not a substrate for neprilysin (61). Clinicians should interpret natriuretic peptides in the context of GDMT; caution is advised when attempting to interpret BNP values in the context of ARNI treatment, and NT-proBNP measurement may be preferable in this setting. However, during treatment, either biomarker predicts the risk of major adverse outcomes in patients treated with sacubitril/valsartan (8). 5.2.6. 