Both approaches were tolerated similarly, but the gradual titration approach maximized attainment of the target dose of sacubitril/ valsartan in patients previously receiving low doses of an ACEI/ARB. Indications for ARNI, Ivabradine, and SGLT2 Inhibitor Use Indications for Use of an ARNI n HFrEF (EF #40%) n NYHA class II IV HF n Administered in conjunction with a background of GDMT for HF in place of an ACEI or ARB Indications for Use of Ivabradine n HFrEF (EF #35%) n On maximum tolerated dose of beta-blocker n Sinus rhythm with a resting heart rate $70 beats/min n NYHA class II or III HF Indications for Use of an SGLT2 Inhibitor n HFrEF (EF #40%) with or without diabetes n NYHA class II IV HF n Administered in conjunction with a background of GDMT for HF ACEI angiotensin-converting-enzyme inhibitor; ARB angiotensin receptor blocker; ARNI angiotensin receptor-neprilysin inhibitor; EF ejection fraction; GDMT guideline-directed medical therapy; HF heart failure; HFrEF heart failure with reduced ejection fraction; NYHA New York Heart Association; SGLT2 sodium- glucose cotransporter-2. J Maddox et al. An ideal time to consider therapy optimization is during hospitalization for HFrEF, and the reader is directed to the 2019 ACC Expert Consensus Decision Pathway on Risk Assessment, Management, and Clinical Trajectory of Pa- tients Hospitalized With Heart Failure (22). Although dis- cussion of hospital-based initiation of sacubitril/valsartan is outside of the scope of this document, it is important to prioritize ongoing titration of GDMT for patients during the hospital-to-home transition. 