CRT is not recommended for patients with NYHA class I or II symptoms and non-LBBB pattern with a QRS dura- tion of less than 150 ms (253,254,272). (Level of Evidence: B) 2. CRT is not indicated for patients whose comorbidities and/ or frailty limit survival with good functional capacity to less than 1 year (37). (Level of Evidence: C) See Figure 2, indications for CRT therapy algorithm. Table 15. Strategies for Achieving Optimal GDMT 1. Uptitrate in small increments to the recommended target dose or the highest tolerated dose for those medications listed in Table 11 with an appreciation that some patients cannot tolerate the full recommended doses of all medications, particularly patients with low baseline heart rate or blood pressure or with a tendency to postural symptoms. 2. Certain patients (e.g., the elderly, patients with chronic kidney disease) may require more frequent visits and laboratory monitoring during dose titration and more gradual dose changes. However, such vulnerable patients may accrue considerable benefits from GDMT. Inability to tolerate optimal doses of GDMT may change after disease-modifying interventions such as CRT. 3. Monitor vital signs closely before and during uptitration, including postural changes in blood pressure or heart rate, particularly in patients with orthostatic symptoms, bradycardia, and/or low systolic blood pressure (e.g., 80 to 100 mm Hg). 4. Alternate adjustments of different medication classes (especially ACE inhibitors/ARBs and beta blockers) listed in Table 11. Patients with elevated or normal blood pressure and heart rate may tolerate faster incremental increases in dosages. 5. Monitor renal function and electrolytes for rising creatinine and hyperkalemia, recognizing that an initial rise in creatinine may be expected and does not necessarily require discontinuation of therapy; discuss tolerable levels of creatinine above baseline with a nephrologist if necessary. 6. 