Every patient with HF should have a clear, detailed, and evidence-based plan of care that ensures the achievement of GDMT goals, effective management of comorbid condi- tions, timely follow-up with the healthcare team, appropriate dietary and physical activities, and compliance with secondary prevention guidelines for cardiovascular disease. This plan of care should be updated regularly and made readily available to all members of each patient s healthcare team (14). (Level of Evidence: C) 3. Palliative and supportive care is effective for patients with symptomatic advanced HF to improve quality of life (31,378 381). (Level of Evidence: B) 11. Quality Metrics/Performance Measures: Recommendations CLASS I 1. Performance measures based on professionally developed clinical practice guidelines should be used with the goal of improving quality of care for HF (334,343,382). (Level of Evidence: B) CLASS IIa 1. Participation in quality improvement programs and patient registries based on nationally endorsed, clinical practice guidelineLbased quality and performance measures can be bene cial in improving quality of HF care (334,343). (Level of Evidence: B) See Table 26 for a revised ACCF/AHA/PCPI 2011 HF measurement set. 12. Evidence Gaps and Future Research Directions Despite the objective evidence compiled by the writing committee on the basis of hundreds of clinical trials, there are huge gaps in our knowledge base about many fundamental aspects of HF care. Some key examples include an effective management strategy for patients with HFpEF beyond blood pressure control; a convincing method to use biomarkers in the optimizationofmedicaltherapy;therecognitionandtreatmentof cardiorenalsyndrome; andthe critical needfor improving patient adherence to therapeutic regimens. Even the widely embraced dictum of sodium restriction in HF is not well supported by current evidence. 