IIb B-NR In patients with chronic HF, measurement of other clinically available tests, such as biomarkers of myocardial injury or fibrosis, may be considered for additive risk stratification.27,95,98,99,103,114 119 MODIFIED: 2013 recommendations have been combined into prognosis section, resulting in LOE change from A to B-NR. See Online Data Supplements A and B. Biomarkers of myocardial fibrosis (eg, soluble ST2 receptor, galectin-3, high-sensitivity cardiac troponin, and others) are predictive of hospitalization and death in patients with HF and also are additive to natriuretic peptide biomarker levels in their prognostic value.117,119 126 A combination of biomarkers may ultimately prove to be more informative than single biomarkers.127 Biomarkers: Recommendations for Prognosis (Continued) COR LOE Recommendations Comment/Rationale Yancy et al 7. Treatment of Stages A to D 7.3. Stage C 7.3.2. Pharmacological Treatment for Stage C HF With Reduced Ejection Fraction: Recommendations (See Figure 2 and Table 3). 7.3.2.10. Renin-Angiotensin System Inhibition With Angiotensin-Converting Enzyme Inhibitor or Angiotensin Receptor Blocker or ARNI: Recommendations Recommendations for Renin-Angiotensin System Inhibition With ACE Inhibitor or ARB or ARNI COR LOE Recommendations Comment/Rationale I ACE-I: A The clinical strategy of inhibition of the renin-angiotensin system with ACE inhibitors (Level of Evidence: A),128 133 OR ARBs (Level of Evidence: OR ARNI (Level of Evidence: B-R)138 in conjunction with evidence- based beta blockers,9,139,140 and aldosterone antagonists in selected is recommended for patients with chronic HFrEF to reduce morbidity and mortality. NEW: New clinical trial data prompted clarification and important updates. ARB: A ARNI: B-R See Online Data 18-20. Angiotensin-converting enzyme (ACE) inhibitors reduce morbidity and mortality in heart failure with reduced ejection fraction (HFrEF). 