Consider altering diuretic dose if applicable n Ketoacidosis in patients with diabetes: n Temporary discontinuation before scheduled surgery is recommended to avoid potential risk for ketoacidosis n Assess patients who present with signs and symptoms of metabolic acidosis for ketoacidosis, regardless of blood glucose level n Acute kidney injury and impairment in renal function: consider temporarily discontinuing in settings of reduced oral intake or uid losses n Urosepsis and pyelonephritis: evaluate patients for signs and symptoms of urinary tract infections and treat promptly, if indicated n Necrotizing fasciitis of the perineum (Fournier s gangrene): rare, serious, life-threatening cases have occurred in both female and male patients; assess patients presenting with pain or tenderness, erythema, or swelling in the genital or perineal area, along with fever or malaise *This population was not studied in PARADIGM-HF. The statement is consistent with FDA-approved labeling indications. ACEI angiotensin converting enzyme inhibitor; AF atrial brillation; ARB angiotensin receptor blocker; EF ejection fraction; eGFR estimated glomerular ltration rate; ESRD end-stage renal disease; FDA Food and Drug Administration; HF heart failure; HFpEF heart failure with preserved ejection fraction; PARADIGM-HF Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in HF; SGLT2 sodium-glucose cotransporter-2. J Maddox et al. up-titrated to the maximum tolerated or target dose as long as the patients remain asymptomatic. Ivabradine is an adjunctive means to reduce the heart rate in patients with chronic HFrEF who are in sinus rhythm. Ivabradine is a speci c inhibitor of the If current involved in sinoatrial nodal activity and reduces the heart rate of patients in normal sinus rhythm without lowering blood pressure. 