Diuretics vs. Afterload Reduction for Treatment of HeartLogic Alerts

Inclusion Criteria:

• Boston Scientific device with HeartLogic enabled
• Lack of standard contraindications to Sacubitril/valsartan:
• history of ACE-inhibitor induced angioedema and in those with angiotensin IIreceptor blocker (ARB) therapy induced angioedema.
• hypotension, hypovolemia
• renal artery stenosis, renal failure
• hyperkalemia
• hepatic disease Child-Pugh class C
• Pregnancy/Breast-feeding
• Lack of standard contraindications to diuretic therapy
• Systolic Blood Pressure > 105

Exclusion Criteria:

• Glomerular filtration rate <25 mL/min who are non-responsive to diuretic therapy orare on chronic renal dialysis
• ongoing symptoms of heart failure decompensation (increased dyspnea and/or fatigue,for purposes of this study increased weight is not considered, see question 2 KCCQ).
• recent significant change in arrhythmia burden (within the past 2 weeks)
• in cardiac resynchronization therapy (CRT) patients, recent change (60 days) ineffective delivery of CRT (eg. decreased biventricular paving %)
• the subject is unable to sign or refuses to sign the patient informed consent
• Symptomatic heart failure at rest or New York Heart Association Class IV at the timeof enrollment
• the subject is implanted with unipolar right atrial or right ventricular leads
• subject has received or is scheduled to receive a heart transplant or ventricularassist device within the next 6 months
• subject is pregnant or planning to become pregnant during the study
• regularly scheduled IV heart failure therapy (e.g. inotropes or diuretics)