Guiding Evidence Based Therapy Using Biomarker Intensified Treatment

Inclusion Criteria:

Age 18 years or older
Most recent LVEF to be ≤ 40% by any method within 12 months of randomization.
High risk heart failure as defined by the following criteria:

A Heart Failure Event in the prior 12 months, defined as any one of the following:

HF Hospitalization
Treatment in the Emergency Department (or equivalent) for Heart Failure
Outpatient treatment for heart failure with intravenous diuretics

AND

NT-proBNP greater than 2000 pg/mL or BNP greater than 400 pg/mL at any time during the 30 days prior to randomization
Willing to provide informed consent

Exclusion Criteria:

Acute coronary syndrome (clinical diagnosis) or cardiac revascularization procedure within 30 days
Cardiac resynchronization therapy (CRT) within prior 3 months or current plan to implant CRT device
Active myocarditis, Hypertrophic obstructive cardiomyopathy, pericarditis, or restrictive cardiomyopathy
Severe stenotic valvular disease
Anticipated heart transplantation or ventricular assist device within 12 months
Chronic inotropic therapy
Complex congenital heart disease
End stage renal disease with renal replacement therapy
Non cardiac terminal illness with expected survival less than 12 months
Women who are pregnant or planning to become pregnant
Inability to comply with planned study procedures
Enrollment or planned enrollment in another clinical trial