Creatinine should be 2.5 mg/dL or less in men or 2.0 mg/dL or less in women (or estimated glomerular ltration rate >30 ), and potassium should be less than 5.0 mEq/L. Careful monitoring of potassium, renal function, and diuretic dosing should be performed at initiation and closely followed thereafter to minimize risk of hyperkalemia and renal insuf ciency (181,182,197). (Level of Evidence: A) 2. Aldosterone receptor antagonists are recommended to reduce morbidity and mortality following an acute MI in patients who have LVEF of 40% or less who develop symp- toms of HF or have a history of diabetes mellitus, unless contraindicated (184). (Level of Evidence: B) CLASS III: HARM 1. Inappropriate use of aldosterone receptor antagonists is potentially harmful because of life-threatening hyperkalemia or renal insuf ciency when serum creatinine is greater than HFrEF Stage C NYHA Class I IV Treatment: For NYHA class II-IV patients. Provided estimated creatinine >30 mL/min and K+ <5.0 mEq/dL For persistently symptomatic African Americans, NYHA class III-IV Class I, LOE A ACEI or ARB AND Beta Blocker Class I, LOE C Loop Diuretics Class I, LOE A Hydral-Nitrates Class I, LOE A Aldosterone Antagonist Add Add Add For all volume overload, NYHA class II-IV patients Figure 1. Stage C HFrEF: evidence-based, guideline-directed medical therapy. ACEI indicates angiotensin-converting enzyme inhibitor; ARB, angiotensin-receptor blocker; HFrEF, heart failure with reduced ejection fraction; Hydral-Nitrates, hydralazine and isosorbide dinitrate; LOE, Level of Evidence; and NYHA, New York Heart Association. JACC Vol. 62, No. 16, 2013 Yancy et al. October 15, 2013:1495 539 2013 ACCF/AHA Heart Failure Guidelines: Executive Summary 2.5 mg/dL in men or greater than 2.0 mg/dL in women (or ), and/or potassium greater than 5.0 mEq/L (198,199). (Level of Evidence: B) 6.3.2.6. HYDRALAZINE AND ISOSORBIDE DINITRATE CLASS I 1. 