In the 2016 ACC/AHA/HFSA HF guideline update (6), ivabradine was recommended as a Class IIa, Level of Ev- idence: B-R (3,4) therapy to reduce the risk of HF hospi- talization in patients with HFrEF (LVEF #35%) already receiving GDMT (including a beta-blocker at the maxi- mally tolerated dose), and who are in sinus rhythm with a heart rate greater than 70 beats/min at rest (Figures 2 and 3, Tables 1, 2, and 5). The contraindications to ivabradine are enumerated in Table 4. The use of SGLT2 inhibitors for general CV risk reduction was recently covered in the ACC s 2020 Expert Consensus Decision Pathway on Novel Therapies for Cardiovascular Risk Reduction in Patients With Type 2 Diabetes (31). This document, however, was not speci cally focused on the emerging role of SGLT2 inhibitors for HFrEF care. Among patients with prevalent HFrEF, data support an SGLT2 inhibitor as valuable therapy, with evidence showing a reduced risk for major events (such as hospi- talization or death) regardless of the presence of diabetes. Although the mechanism of bene t from these agents in HFrEF remains uncertain, treatment with SGLT2 in- hibitors leads to osmotic diuresis and natriuresis, de- creases in arterial pressure and stiffness, and a shift to ketone-based myocardial metabolism (32). Further bene- ts may be due to reduction of preload and afterload blunting of cardiac stress/injury with less hypertrophy and brosis, which would have favorable effects on myocardial remodeling. The rst study to demonstrate a bene t of SGLT2 in- hibitors for HFrEF care examined the role of dapagli ozin in patients with HFrEF. 