This suggests that in well-selected patients with recurrent congestion, this highly specialized monitoring strategy may guide thera- peutic decision-making. The impact on mortality is un- known but is being evaluated in an ongoing randomized clinical trial, GUIDE-HF (Hemodynamic-Guided Manage- ment of HF). A team-based approach may be necessary to best deploy this monitoring strategy (see Section 5.8). Patients on optimal GDMT who have either high-risk features (Section 5.3 and Table 6) or a poor response to therapy should be considered for referral to an advanced HF specialist, as discussed in the next section. 5.3. When to Refer to an HF Specialist Appropriate and timely referral to an HF specialist and/or HF program is essential in selected patients to optimize therapies and evaluate advanced HF care options (Table 6) (3,64). Referrals should be made for consultation and, if indicated, for comanagement as well as consider- ation of advanced therapies (heart transplantation or mechanical circulatory support), recognition and man- agement of speci c or unusual cardiomyopathies, or annual review (3,65 71). Clinical triggers for referral (Table 6) include persistent or worsening symptoms, adverse clinical events, or other features suggesting that the patient is at high risk for disease progression or death (53,72 75). 5.4. How to Address Challenges of Care Coordination Delivering optimal patient-centered HF care is complex. The range of treatments available, particularly those for patients with HFrEF, include multiple medications, car- diac devices, surgery, and lifestyle adaptations, all of which require education, monitoring, and engagement. 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. 