Consensus Pathway Algorithm for Initiation and Titration of HFrEF Therapies Figures 2 and 3 depict a strategy for initiating and titrating evidence-based therapies for patients with HFrEF. As noted in the previous text, after a diagnosis of HF is made, adjustment of therapies should occur every 2 weeks, and some patients may tolerate more rapid titration of GDMT. Clinicians should aim to achieve optimal GDMT within 3 to 6 months of an initial diagnosis of HF (however, this rapid timeline may not be logistically feasible for some patients). GDMT should continue to be up-titrated to achieve maximally tolerated or targeted doses of these therapies. During follow-up, frequent reassessment of the clinical status of the patient, blood pressure, and kidney function (and electrolytes) should be performed. Struc- tured medication titration plans embedded in disease management programs that articulate a strategy for drug initiation and strategies for follow-up have been shown to be useful in obtaining target doses of GDMT within 6 months of hospital discharge (35). Reassessment of ventricular function should occur 3 to 6 months after target (or maximally tolerated) doses of GDMT are achieved to determine the need for device therapies such as implantable cardioverter-de brillators and cardiac resynchronization therapy. For those at higher risk for sudden death (e.g., with ischemic cardio- myopathy, LVEF <30%, evidence for ventricular ectopy), the time to follow-up imaging might be shorter (e.g., 3 months), whereas in those at lower risk, time to follow-up might be longer (e.g., 6 months) (3). In patients who already have such devices, reimaging might be deferred even further. 5.1.7. Severe Mitral Regurgitation and the Use of Transcatheter Mitral Valve Repair Surgical treatment is recommended in cases of severe primary chronic MR resulting in HFrEF (36). 