The trial also showed that treatment with empagli ozin slowed the decline in the eGFR over time (13). A subsequent meta-analysis of DAPA-HF and EMPEROR-Reduced suggested that the effects of empa- gli ozin and dapagli ozin on hospitalization for HF were consistent and that these agents reduced all-cause and CV death and improved renal outcomes in patients (34). The dosing for SGLT2 inhibitors is detailed in Table 1, whereas cautions and contraindications for SGLT2 in- hibitors are enumerated in Table 4. The DAPA-HF trial did not enroll patients with an eGFR <30 mL/min/1.73 , yet dapagli ozin is approved for HFrEF care in pa- tients with worse renal function. The lower limit of eGFR for inclusion in the EMPEROR-Reduced trial was . The writing committee recognizes that glucosuric effects of SGLT2 inhibitors may be TABLE 5 Recommended Starting Dose of Ivabradine Population Initial Dose Maximally tolerated beta-blocker dose with persistent resting heart rate $70 beats/min 5 mg twice daily with meals History of conduction defects 2.5 mg twice daily with meals Age $75 years Maddox et al. J attenuated in those with eGFRs below these thresholds; bene ts of SGLT2 inhibitors for HFrEF management in those with more advanced renal dysfunction than the patients in these recent studies remains less clear. Caution is advised when using SGLT2 inhibitors in pa- tients with eGFRs below the inclusion criteria from pivotal studies, particularly as SGLT2 inhibitors have been associated with mild worsening of renal function during the rst year of use. 5.1.6. Consensus Pathway Algorithm for Initiation and Titration of HFrEF Therapies Figures 2 and 3 depict a strategy for initiating and titrating evidence-based therapies for patients with HFrEF. 