Patients whose natriuretic peptide concentrations do not fall with GDMT ( nonresponders ) have a worse prognosis and more deleterious LV remodeling (7,57,58). In the GUIDE-IT (Guiding Evidence Based Therapy Using Biomarker Intensi ed Treatment in HF) trial, among patients with HFrEF, lowering NT-proBNP to <1,000 pg/mL was asso- ciated with signi cant reverse remodeling and improved outcomes (59). Similarly, in the PROVE-HF study, the speed and magnitude of NT-proBNP lowering after ARNI initiation were associated with greater degrees of reverse cardiac remodeling and improved outcomes (7,54). Therefore, measurement of BNP or NT-proBNP is useful to monitor risk, assist in decision-making regarding the ordering of imaging studies to evaluate LV remodeling, and to provide helpful objective data regarding decision- making for referral to advanced HF therapies (Figure 4, Table 6). Concentrations of BNP or NT-proBNP are sup- ported with a Class I guideline recommendation to determine prognosis. In the setting of worsening TABLE 6 Triggers for HF Patient Referral to a Specialist/Program Clinical Scenario 1. New-onset HF (regardless of EF): Refer for evaluation of etiology, guideline-directed evaluation and management of recommended therapies, and assistance in disease management, including consideration of advanced imaging, endomyocardial biopsy, or genetic testing for primary evaluation of new-onset HF 2. 