Some apparently well-compensated patients on optimal beta-blocker therapy continue to have a persis- tent resting heart rate over 70 beats/min, and some pa- tients do not tolerate up-titration of beta-blockade to the target dose and have an elevated heart r ate. In patients on low-dose beta-blockers who may have heart rates below 70 beats/min, a beta-blocker should continue to be TABLE 4 Contraindications and Cautions for Sacubitril/Valsartan, Ivabradine, and SGLT2 inhibitors A) Sacubitril/Valsartan Contraindications Cautions n Within 36 hours of ACEI use n History of angioedema with or without an ACEI or ARB n Pregnancy n Lactation (no data) n Severe hepatic impairment (Child-Pugh C) n Concomitant aliskiren use in patients with diabetes n Known hypersensitivity to either ARBs or ARNIs n Renal impairment: ): no starting dose adjustment required ): reduce starting dose to 24/26 mg twice daily; double the dose every 2 4 weeks to target maintenance dose of 97/103 mg twice daily, as tolerated n Hepatic impairment:  Mild (Child-Pugh A): no starting dose adjustment required  Moderate (Child-Pugh B): reduce starting dose to 24/26 mg twice daily; double the dose every 2 4 weeks to target maintenance dose of 97/103 mg twice daily, as tolerated n Renal artery stenosis n Systolic blood pressure <100 mm Hg n Volume depletion B) Ivabradine Contraindications Cautions n HFpEF n Presence of angina with normal EF n Hypersensitivity n Severe hepatic impairment (Child-Pugh C) n Acute decompensated HF n Blood pressure <90/50 mm Hg n Sick sinus syndrome without a pacemaker n Sinoatrial node block n 2nd or 3rd degree block without a pacemaker n Resting heart rate <60 beats/min n Persistent AF or utter n Atrial pacemaker dependence n Sinus node disease n Cardiac conduction defects n Prolonged QT interval C) SGLT2 Inhibitors Contraindications Cautions n Not approved for use in patients with type I diabetes due to increased risk of diabetic ketoacidosis n Known hypersensitivity to drug n Lactation (no data) n On dialysis n For HF care, dapagli ozin, eGFR <30 mL/min/1.73 m2 n For HF care, empagli ozin, eGFR <20 mL/min/1.73 m2 n Pregnancy n Increased risk of mycotic genital infections n May contribute to volume depletion. 