In some cases, covered topics will be addressed in subsequent clinical practice guidelines as the evidence base evolves. In other cases, these will serve as stand-alone policy. Ty J. Gluckman, MD, FACC Chair, ACC Solution Set Oversight Committee ABSTRACT The 2017 ACC Expert Consensus Decision Pathway for Optimization of Heart Failure Treatment was created to provide a practical, streamlined resource for clinicians managing patients with heart failure with reduced ejec- tion fraction (HFrEF) (2). The 2017 ECDP was based on the 2013 ACCF/American Heart Association (AHA) Guideline for the Management of Heart Failure and the 2017 ACC/ AHA/Heart Failure Society of America (HFSA) Focused Update of the 2013 Guideline (3,4). The 2017 ECDP pro- vided guidance on introducing the numerous evidence- based therapies, improving adherence, overcoming treatment barriers, acknowledging contraindications and situations for which little data exist, affording expensive therapies, treating special cohorts, and making the tran- sition to palliative care. Rather than focusing on extensive text, the document provided practical tips, tables, and gures to make clear the steps, tools, and provisos needed to successfully and expeditiously treat the patient with HFrEF. Many of the pivotal issues addressed in the ECDP were not the substance of clinical trials; rather, they represent the challenge of clinical practice. Since the 2017 ECDP, new therapies for HFrEF have emerged that expand the armamentarium for the treat- ment of patients with HFrEF. In particular, the emergence of angiotensin receptor-neprilysin inhibitors (ARNIs), sodium-glucose cotransporter-2 (SGLT2) inhibitors, and percutaneous therapy for mitral regurgitation (MR) represent signi cant advances in the treatment of HFrEF. As such, a focused update to the 2017 ECDP that in- corporates these advances into the recommendations is warranted. 