Lastly, the considerable impact of the coronavirus disease 2019 (COVID-19) pandemic on outpatient management of chronic disease states such as HFrEF justi es its consideration in this document. To address these newer data and how they relate to prior logic for clinical management of HFrEF, the ACC convened structured discussions to address new thera- pies, unanswered questions, adherence, and imple- mentation strategies. The College also convened multidisciplinary panel discussions, which have been archived for online distribution (https://www.acc.org/ tools-and-practice-support/quality-programs/succeed-in- managing-heart-failure-initiative/emerging-strategies-for- heart-failure-roundtable). Based on those discussions, a writing committee was formed to provide practical guid- ance to address gaps in care related to optimal manage- ment of HF treatment. For this 2021 update, the writing committee convened in mid-2020 on con dential con- ference calls attended only by writing committee mem- bers and ACC staff. When consensus within the writing committee was deemed necessary by the Chair and Vice Chair, either a roll call vote or an email-generated ballot was implemented. A simple majority prevailed; in the presence of a tie, the Chair s prerogative reconciled the nal decision. The formal peer-review process was completed consistent with ACC policy and included a public comment period to obtain further feedback. Following reconciliation of all comments, this document was approved for publication by the Clinical Policy Approval Committee. The ACC and the Solution Set Oversight Committee (SSOC) recognize the importance of avoiding real or J Maddox et al. perceived relationships with industry (RWI) or other en- tities that may affect clinical policy. The ACC maintains a database that tracks all relevant relationships for ACC members and persons who participate in ACC activities, including those involved in the development of ECDPs. ECDPs follow ACC RWI Policy in determining what con- stitutes a relevant relationship, with additional vetting by the SSOC. 