New-onset HF (regardless of EF): Refer for evaluation of etiology, guideline-directed evaluation and management of recommended therapies, and assistance in disease management, including consideration of advanced imaging, endomyocardial biopsy, or genetic testing for primary evaluation of new-onset HF 2. Chronic HF with high-risk features, such as development or persistence of one or more of the following risk factors: n Need for chronic intravenous inotropes n Persistent NYHA functional class III IV symptoms of congestion or profound fatigue n Systolic blood pressure #90 mm Hg or symptomatic hypotension n Creatinine $1.8 mg/dL or BUN $43 mg/dL n Onset of atrial brillation, ventricular arrhythmias, or repetitive ICD shocks n Two or more emergency department visits or hospitalizations for worsening HF in the prior 12 months n Inability to tolerate optimally dosed beta-blockers and/or ACEI/ARB/ARNI and/or aldosterone antagonists n Clinical deterioration, as indicated by worsening edema, rising biomarkers (BNP, NT-proBNP, others), worsened exercise testing, decompensated hemodynamics, or evidence of progressive remodeling on imaging n High mortality risk using a validated risk model for further assessment and consideration of advanced therapies, such as the Seattle Heart Failure Model 3. Persistently reduced LVEF #35% despite GDMT for $3 months: refer for consideration of device therapy in those patients without prior placement of ICD or CRT, unless device therapy is contraindicated or inconsistent with overall goals of care 4. Second opinion needed regarding etiology of HF; for example: n Coronary ischemia and the possible value of revascularization n Valvular heart disease and the possible value of valve repair n Suspected myocarditis n Established or suspected speci c cardiomyopathies (e.g., hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia, Chagas disease, restrictive cardiomyopathy, cardiac sarcoidosis, amyloid, aortic stenosis) 5. 