For example, patients with HFrEF frequently require consultative care delivered by electrophysiology special- ists to implant, monitor, and adjust devices such as implantable cardioverter-de brillator or cardiac resynch- ronization therapy devices. As outlined in Section 5.9, the complexity of HF care is further exacerbated by the frequent coexistence of both cardiac and noncardiac comorbidities found in patients with HF. Comorbidities are particularly common in the elderly. More than 50% of patients with HF on Medicare have 4 or more non-CV comorbidities and more than 25% have 6 or more (76). The care needs for comorbidities can complicate and in some cases prevent the optimal use of HF therapies. Finally, the medical complexity inherent in most patients with HF generally requires the involvement of multiple clinicians across many care settings (e.g., hospitals, rehabilitation facilities, and ambulatory clinics). This raises the risk of inef ciencies in care delivery, miscom- munication, potential drug drug interactions and drug Maddox et al. J disease interactions, and missed opportunities to achieve optimal HF outcomes. As new medications and devices become available that require optimal communication between multiple parties, including the patient, care coordination is especially important. For example, when caring for patients with HF who have comorbid T2D and are being considered for new glucose modifying therapies (SGLT2 inhibitors), possible approaches include a consultative approach or a team approach. In a consultative approach, the CV specialist consults with the diabetes clinician and/or the patient in the provision of their care (31). In a team approach, an interprofessional multidisciplinary group of clinicians (e.g., primary care, endocrinologists, cardiologists, phar- macists, nurses, advanced practice professionals, and di- eticians) consider novel therapies collectively (31). Regardless, all approaches to HFrEF management need to be patient-centered, use shared decision-making, and involve communication across disciplines (31). 