This is a randomized, open-label, initiative within the Mass General Brigham healthcare system testing two remote care strategies for optimizing the prescription of guideline-directed medical therapies in patients with heart failure, regardless of left ventricular ejection fraction (LVEF).

The primary objectives are:

1. Determine if a remote, or virtual, clinic that implements a standardized, stepped-approach to guideline-directed medication optimization in patients with heart failure (across the spectrum of ejection fraction), will achieve a higher rate of guideline-directed medical therapy (GDMT) than a strategy of patient and provider education followed by remote heart failure clinic management.
2. In eligible patients with LVEF<50%, determine if the sequencing of GDMT initiation (traditional vs. sodium-glucose co-transporter-2 inhibitors-first) leads to improved GDMT intensification

Inclusion Criteria:

• Documented diagnosis of heart failure (e.g., ICD-9 codes 428 ICD-10 codes I50 or Problem list in the electronic health record)
• Most recent EF assessed within the past 24 months
• Seen Mass General Brigham provider within the last 24 months
• English or Spanish speaking

Exclusion Criteria:

• LVEF<50% currently prescribed or intolerant to both ARNi and SGLT2i
• LVEF>50% currently prescribed or intolerant to SGLT2i
• Systolic blood pressure (SBP) <90 mmHg at last measure
• Current severe aortic stenosis or severe aortic insufficiency
• Known amyloid heart disease
• Group 1 pulmonary arterial hypertension on disease-specific therapies (e.g., Ambrisentan, Bosentan, Epoprostenol, Treprostinil, Iloprost)
• eGFR<30 mL/min/1.73m2
• Active chemotherapy
• Receiving end-of-life care or hospice
• History of transplant, currently listed above status 4 or being evaluated for transplant
• Outpatient intravenous inotrope use
• Current use of a Ventricular Assist Device
• Physician's discretion as inappropriate for remote management program