Efficacy of a Streamlined Heart Failure Optimization Protocol

Exclusion Criteria

• •Systolic BP of less than 100 mmHg on 2 consecutive measurements
• •Estimated glomerular filtration rate (eGFR) less than 30 ml/min/1.73m2
• •Type 1 diabetes mellitus
• •Cognitive impairment that in the opinion of the investigator may lead the patient to be unable to understand and/or comply with the study medications, procedures and/or follow-up
• •Uncorrected primary valvular disease
• •Active malignancy treatment at time of visit 1
• •Women of child-bearing potential who are not willing to use a medically accepted method of contraception that is reliable in the judgement of the investigator\*
• •Women who are pregnant or breastfeeding
• •History of angioedema, or hereditary or idiopathic angioedema
• •Severe hepatic impairment, biliary cirrhosis or cholestasis
• •Patients who are receiving treatment with an aliskiren-containing product who have diabetes mellitus or renal impairment (eGFR \<60 ml/min/1.73 m2)
• •* Highly effective methods of contraception include implants, injectables, combined oral contraceptives (the participant must have been on a stable dose for at least 3 months before entering the trial), intrauterine device, vasectomised partner, or true sexual abstinence (when this is the preferred and usual lifestyle of the patient and does not include periodic abstinence \[e.g. calendar, ovulation, symptothermal or post-ovulation methods\]). Use of such methods must be maintained throughout the trial and for 7 days after the end of the trial.