It is not yet clear that de novo initiation is best for all patients with HFrEF (such as those with hypotension or very advanced HF), and we do recognize access challenges for some patients with regards to payer coverage and associated costs of ARNIs. Another important development since the publication of the 2017 ECDP is the Food and Drug Administration s approval of a candidate SGLT2 inhibitor and its addition to the armamentarium of medications available for the treatment of patients with HFrEF. In the DAPA-HF (Study to Evaluate the Effect of Dapagli ozin on the Incidence of Worsening HF or CV Death in Patients with Chronic HF) trial, dapagli ozin demonstrated a reduction in CV death and HF hospitalization in patients with and without type 2 diabetes (T2D) (12). In addition, the EMPEROR-Reduced (Empagli ozin Outcome Trial in Patients With Chronic HFrEF) trial demonstrated a reduction in HF hospitaliza- tion/CV death from empagli ozin treatment in patients with HFrEF with and without diabetes (13). As such, it is clear that SLGT2 inhibitors exhibit a bene cial class effect in patients with HFrEF. In light of these developments, an update on when and how to add, switch, and titrate all HFrEF therapies to maximally tolerated, and ideally target, doses (Figure 1, Table 1) was deemed important. 