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JAMA Car- diol. 2020;5:1020 6. 175. de Abajo FJ, Rodriguez-Martin S, Lerma V, et al. Use of renin-angiotensin-aldosterone system inhibitors and risk of COVID-19 requiring admission to hospital: a case-population study. Lancet. 2020;395:1705 14. 176. BRACE CORONA: does temporarily suspending RAAS inhibitors show clinical bene t in hospitalized COVID-19 patients? ACC News Story. Published September 1, 2020. Available at: https://www.acc.org/ ace-inhibitors-arbs-esc-2020. Accessed October 10, 2020. KEY WORDS ACC Expert Consensus Decision Pathway, ARNI, heart failure, HFrEF, SGLT2 inhibitor Maddox et al. J Committee Member Employment Consultant Speakers Bureau Ownership/ Partnership/ Principal Personal Research Institutional, Organizational, or Other Financial Bene t Expert Witness Thomas M. Maddox (Chair) BJC HealthCare and Washington University School of Medicine Executive Director, Healthcare Innovation Lab; Professor of Medicine None None None None None None James L. Januzzi Jr. (Vice Chair) Harvard Medical School Hutter Family Professor of Medicine; Director, Dennis and Marilyn Barry Fellowship in Cardiology Research; Senior Cardiometabolic Faculty, Baim Institute for Clinical Research n Abbott n Roche Diagnostics* None None n Abbott* n Amgen (DSMB)* n Boehringer Ingel- heim (DSMB)* n Janssen Pharmaceu- ticals (DSMB)* n Novartis* None None Larry A. Allen University of Colorado School of Medicine Associate Professor of Medicine n Abbott n Amgen n Boston Scienti c n Novartis None None None n Janssen None Khadijah Breathett University of Arizona College of Medicine Assistant Professor of Medicine, Division of Cardiology, Advanced Heart Failure and Transplant None None None None None None Javed Butler University of Mississippi Medical Center Patrick H. Lehan Professor; Chairman, Department of Medicine n Abbott n AstraZeneca n Boehringer Ingelheim* n Eli Lilly* n Janssen* n Medtronic n Novartis* n Relypsa* n Roche Diagnostics n Janssen* n Novartis* None n Amgen (DSMB) n Bristol-Myers Squibb (DSMB) None None Leslie L. Davis University of North Carolina at Chapel Hill Associate Professor of Nursing None None None None n AANP None Gregg C. Fonarow David Geffen School of Medicine, UCLA Division of Cardiology Professor of Medicine n Abbott* n Amgen n AstraZeneca n CHF Solutions Lifesciences* n Janssen n Medtronic n Novartis* None None None n Boston Scienti c None Continued on the next page APPENDIX 1. AUTHOR RELATIONSHIPS WITH INDUSTRY AND OTHER ENTITIES (RELEVANT) 2021 UPDATE TO THE ACC EXPERT CONSENSUS DECISION PATHWAY ON OPTIMIZATION OF HEART FAILURE TREATMENT: ANSWERS TO 10 PIVOTAL QUESTIONS ABOUT HEART FAILURE WITH REDUCED EJECTION FRACTION To avoid actual, potential, or perceived con icts of interest that may arise as a result of industry relationships or personal interests among the writing committee, all members of the writing committee, as well as peer reviewers of the document, are asked to disclose all current healthcare-related relationships, including those existing 12 months before initiation of the writing effort. The ACC Task Force on Expert Consensus Decision Pathways reviews these disclosures to determine what companies make products (on market or in development) that pertain to the document under development. Based on this information, a writing committee is formed to include a majority of members with no relevant relationships with industry (RWI), led by a chair with no relevant RWI. RWI is reviewed on all conference calls and updated as changes occur. Author RWI pertinent to this document is disclosed in the table below and peer reviewer RWI is disclosed in Appendix 2. Addi- tionally, to ensure complete transparency, authors comprehensive disclosure information including RWI not pertinent to this document is available in a Supplemental Appendix 1. Disclosure information for the ACC Task Force on Expert Consensus Decision Pathways is also available online at http://www.acc.org/guidelines/about-guidelines-and-clinical- documents/guidelines-and-documents-task-forces, as well as the ACC disclosure policy for document development at http://www.acc.org/guidelines/about-guidelines-and-clinical-documents/relationships-with-industry-policy. J Maddox et al. Committee Member Employment Consultant Speakers Bureau Ownership/ Partnership/ Principal Personal Research Institutional, Organizational, or Other Financial Bene t Expert Witness Nasrien E. Ibrahim Massachusetts General Hospital Assistant Professor of Medicine, Harvard Medical School; Associate Director, Resynchronization and Advanced Cardiac Therapeutics Program, Massachusetts General Hospital n Roche Diagnostics None None n Boehringer Ingelheim n Novartis None None JoAnn Lindenfeld Vanderbilt University Director, Heart Failure and Transplantation Program n Abbott n AstraZeneca n Boehringer Ingelheim n Edwards Lifesciences n Novartis None None n AstraZeneca None None Frederick A. Masoudi University of Colorado Anschutz Medical Campus Professor of Medicine None None None None None None Shweta R. Motiwala Beth Israel Deaconess Medical Center, Harvard Medical School Instructor in Medicine n Eli Lilly None None n Relypsa None None Estefania Oliveros Temple University Hospital Pulmonary Hypertension, Right Heart Failure and CTEPH Program None None None None None None J. Herbert Patterson University of North Carolina Eshelman School of Pharmacy Professor of Pharmacy and Research Professor of Medicine n Novartis* None None n Amgen n Boehringer Ingelheim n Novartis None None Mary Norine Walsh St. Vincent Heart Center of Indiana Medical Director, Heart Failure and Cardiac Transplantation None None None None None None Alan Wasserman The George Washington University School of Medicine and Health Sciences Eugene Meyer Professor of Medicine; Chairman, Department of Medicine None None None None None None Clyde W. Yancy Northwestern University, Feinberg School of Medicine Vice Dean, Diversity and Inclusion; Magerstadt Professor of Medicine; Chief, Division of Cardiology None None None None None None Quentin R. Youmans Northwestern University Feinberg School of Medicine Fellow, Division of Cardiology, Department of Medicine None None None None None None This table represents the relationships of committee members with industry and other entities that were determined to be relevant to this document. These relationships were reviewed and updated in conjunction with all meetings and/or conference calls of the writing committee during the document development process. The table does not necessarily re ect relationships with industry at the time of publication. A person is deemed to have a signi cant interest in a business if the interest represents ownership of $5% of the voting stock or share of the business entity, or ownership of $$5,000 of the fair market value of the business entity; or if funds received by the person from the business entity exceed 5% of the person s gross income for the previous year. Relationships that exist with no nancial bene t are also included for the purpose of transparency. Relationships in this table are modest unless otherwise noted. According to the ACC, a person has a relevant relationship IF: a) the relationship or interest relates to the same or similar subject matter, intellectual property or asset, topic, or issue addressed in the document; b) the company/entity (with whom the relationship exists) makes a drug, drug class, or device addressed in the document or makes a competing drug or device addressed in the document; or c) the person or a member of the person s household has a reasonable potential for nancial, professional, or other personal gain or loss as a result of the issues/content addressed in the document. *Signi cant relationship No nancial bene t. AANP American Association of Nurse Practitioners; ACC American College of Cardiology; DSMB Data Safety Monitoring Board; CTEPH chronic thromboembolic pulmonary hypertension; UCLA University of California, Los Angeles. APPENDIX 1. CONTINUED Maddox et al. J Reviewer Representation Employment Frank V. Aguirre Of cial Reviewer Board of Governors Prairie Cardiovascular Consultants Interventional Cardiologist Nancy M. Albert Content Reviewer ACC Expert Cleveland Clinic Associate Chief Nursing Of cer, Research and Innovation Nicole Martin Bhave Content Reviewer Solution Set Oversight Committee University of Michigan Associate Professor of Cardiovascular Medicine Donald E. Casey Jr. Content Reviewer 2017 Heart Failure Guideline Writing Committee IPO 4 Health Principal Chad Darling Content Reviewer University of Massachusetts Medical School Associate Professor, Department of Emergency Medicine Gregory J. Dehmer Content Reviewer Solution Set Oversight Committee Virginia Tech Carilion School of Medicine; Carilion Clinic, Cardiology and Carilion Cardiovascular Institute Medical Director, Quality and Outcomes James C. Fang Content Reviewer ACC Heart Failure Council University of Utah School of Medicine Chief of Cardiovascular Medicine; University of Utah Health Care Director, Cardiovascular Service Line Barbara Fletcher Content Reviewer University of North Florida Associate Professor of Medicine Olivia N. Gilbert Of cial Reviewer Solution Set Oversight Committee Wake Forest School of Medicine Assistant Professor, Advanced Heart Failure and Transplant Cardiology Tyler J. Gluckman Content Reviewer Solution Set Oversight Committee, Chair Providence Heart Institute, Providence St. Joseph Health Medical Director, Center for Cardiovascular Analytics, Research and Data Science (CARDS); Johns Hopkins Hospital Adjunct Faculty, Ciccarone Center for the Prevention of Heart Disease Lee R. Goldberg Content Reviewer ACC Expert Hospital of the University of Pennsylvania Vice Chair of Medicine Steven M. Hollenberg Content Reviewer 2019 Heart Failure Expert Consensus Decision Pathway Writing Committee Hackensack Meridian University Hospital Professor of Medicine Mariell Jessup Content Reviewer 2017 Heart Failure Guideline Writing Committee American Heart Association Chief Scienti c Of cer James N. Kirkpatrick Content Reviewer 2019 Heart Failure Expert Consensus Decision Pathway Writing Committee University of Washington Medical Center Associate Professor of Medicine, Division of Cardiology; Director, Echocardiography Michelle Maya Kittleson Content Reviewer 2020 Heart Failure Guideline Writing Committee Cedars-Sinai Director, Heart Failure Research; Director, Post-Graduate Education in Heart Failure and Transplantation; Professor of Medicine, Smidt Heart Institute Chayakrit Krittanawong Content Reviewer Solution Set Oversight Committee Baylor College of Medicine and The Michael E. DeBakey VA Medical Center Physician Phillip David Levy Content Reviewer Wayne State University Assistant Vice President; Associate Professor of Emergency Medicine; Associate Director of Clinical Research, Department of Emergency Medicine Judith A. Mackall Content Reviewer Heart Rhythm Society University Hospital of Cleveland, Division of Cardiology Director, Device Clinic; Case Western Reserve University School of Medicine Associate Professor of Medicine Gurusher S. Panjrath Content Reviewer ACC Heart Failure Council George Washington University Director, Heart Failure and Mechanical Support Program Sita S. Price Content Reviewer Elite Cardiac Care, LLC Administrator/Director of Nursing Lynne Warner Stevenson Content Reviewer 2019 Heart Failure Expert Consensus Decision Pathway Writing Committee Vanderbilt University Director, Cardiomyopathy and Heart Failure Program David E. Winchester Content Reviewer Solution Set Oversight Committee University of Florida College of Medicine Associate Professor of Medicine; Malcom Randall VAMC Staff Cardiologist; Assistant Cardiology Fellowship Program Director, Quality and Research; Co-Director, Advanced Fellowship for Cardiovascular Imaging; Co-Director, University of Florida Health Cardiac Imaging Group ACC American College of Cardiology; VA Veterans Administration; VAMC Veterans Administration Medical Center. APPENDIX 2. PEER REVIEWER INFORMATION 2021 UPDATE TO THE 2017 ACC EXPERT CONSENSUS DECISION PATHWAY FOR OPTIMIZATION OF HEART FAILURE TREATMENT: ANSWERS TO 10 PIVOTAL ISSUES ABOUT HEART FAILURE WITH REDUCED EJECTION FRACTION This table represents the individuals, organizations, and groups that peer-reviewed this document. A list of corre- sponding comprehensive healthcare-related disclosures for each reviewer is available in a Supplemental Appendix 3. J Maddox et al. APPENDIX 3. ABBREVIATIONS ACC American College of Cardiology ACEI angiotensin-converting enzyme inhibitor AF atrial brillation AHA American Heart Association ARB angiotensin receptor blocker ARNI angiotensin receptor-neprilysin inhibitor BNP B-type natriuretic peptide CI con dence interval COVID-19 coronavirus disease 2019 CV cardiovascular ECDP expert consensus decision pathway EF ejection fraction eGFR estimated glomerular ltration rate GDMT guideline-directed medical therapy HF heart failure HFrEF heart failure with reduced ejection fraction HFSA Heart Failure Society of America HYD/ISDN hydralazine/isosorbide dinitrate LV left ventricular LVEF left ventricular ejection fraction MR mitral regurgitation NT-proBNP N-terminal pro B-type natriuretic peptide NYHA New York Heart Association RWI relationships with industry SSOC Solution Set Oversight Committee T2D type 2 diabetes Maddox et al. J