PHARM Optimal-HF Pilot

Inclusion criteria

• Provision of signed and dated informed consent form;
• Stated willingness to comply with all study procedures and availability for the duration of the study;
• Age ≥18 years;
• Clinic diagnosis of HF with New York Heart Association (NYHA) functional class 1 to 3 at time of screening;
• Left ventricular ejection fraction (LVEF) ≤40% on cardiac imaging performed within 6 months prior to enrolment;
• Willingness to receive medications for the management of HFrEF;
• Access to necessary resources for participating (telephone ± computer with internet access).

Exclusion criteria

• Already receiving target doses of sacubitril-valsartan, evidence-based beta-blocker and a mineralocorticoid receptor antagonist at time of screening;
• Lying/sitting systolic blood pressure <90 mm Hg at time of enrolment;
• Serum potassium ≥5.5 mmol/L at time of enrolment;
• ≥2 measurements indicating estimated glomerular filtration rate (eGFR) <30 mL/min/1.73m2 within 3 months prior to enrolment;
• Being considered for heart transplant, durable mechanical circulatory support, or intravenous inotropes at time of screening;
• Requiring diuretic dose greater than furosemide 80 mg equivalents or requiring the addition of a thiazide-like diuretic for more than 3 days at time of screening;
• Felt by the multidisciplinary HF clinic team to be unsuitable for the trial (e.g. substance abuse and other psychological disorders, significant language barrier).