Socioeconomic barriers to care may undermine the ability to achieve GDMT. For example, the cost of thera- pies poses a substantial barrier to care, particularly for an ARNI, SGLT2 inhibitor, and ivabradine (see the discussion on costs of care in Section 5.7). In such cases, if all solu- tions are exhausted, optimizing care with the most nancially manageable program is recommended. Simi- larly, some patients have a limited ability to attend frequent of ce visits for GDMT optimization. For example, homebound patients or those with limited ability to travel may be unable to have blood pressure, heart rate, or renal function assessed in a timely fashion. In these cases, options such as virtual care and home visiting nurse services may aid in remote optimization of GDMT (49). Virtual care in particular may be a more viable strategy, with the recent increases in its use due to the COVID-19 pandemic. Useful guidance exists regarding the use of virtual visits to allow for medical access, moni- toring of symptoms/signs, and adjustments of GDMT (50). 5.2.3. Clinical Assessment Figure 4 details a reasonable strategy for patient evalua- tion and management following a diagnosis of HFrEF. After GDMT is initiated and titrated with the goal of achieving clinical trial doses or maximally tolerated doses, patients with chronic HFrEF should be evaluated on a regularly scheduled basis. For most patients, a reasonable interval is every 3 to 6 months, although many may require more frequent follow-up to monitor clinical stability and revisit opportunities for further GDMT titration. Cardiac rehabilitation is helpful to support drug titration, monitor symptoms, improve health status, and increase exercise tolerance, but remains underused in terms of both prescription and access (51). 