For optimal titration of an ARNI/ACEI/ARB, lower loop diuretic doses may be necessary to permit titration; in this circumstance, careful attention to potassium concentra- tions is needed, as the kaliuretic effects of loop diuretics may no longer be present, and restriction of supplemental and/or dietary potassium may be necessary. Aldosterone antagonists are added in as part of the therapy for patients with symptomatic chronic HFrEF who are already receiving beta-blockers and an ARNI/ ACEI/ARB and who do not have contraindications to this therapy (3). It is not necessary to achieve target or maxi- mally tolerated doses of other drugs before adding aldo- sterone antagonists. The doses of aldosterone antagonists used in clinical trials, which are typically below those that might in uence blood pressure, are suf cient for clinical ef cacy. Adherence to the guideline recommendations for monitoring of renal function and potassium is required (4). SGLT2 inhibitors are added in as part of the therapy for patients with chronic HFrEF who are already receiving beta-blockers, an ARNI/ACEI/ARB, and aldosterone an- tagonists, if not contraindicated. There is little data addressing the combination of an ARNI and an SGLT2 inhibitor. However, in both DAPA-HF and EMPEROR- Reduced, the bene t of SGLT2 inhibition was consistent in patients already treated with an ARNI, and a meta- analysis of the 2 trials af rms this nding (12,34,44). In the DAPA-HF trial, among the small number of patients receiving an ARNI, additive bene t was seen across each timepoint from the addition of dapagli ozin (45). Achieving target or maximally tolerated doses of other drugs is not necessary before adding SGLT2 inhibitors. The loop diuretic dose may need to be adjusted based on close monitoring of weight and symptoms (46). 