Diagnosis of NYHA Class III Heart Failure.

At least 1 HF hospitalization within preceding 12 months.

Subjects with reduced LVEF heart failure should be receiving a beta blocker for 3 months and an ACE-I or ARB for one month unless in the subject is intolerant to beta blockers, ACE-I or ARB.

Subjects with a BMI ≤ 35.

Documented past history of myocardial infarction OR past evidence of multivessel coronary artery disease by angiography.

History of type 2 diabetes or metabolic syndrome at time of study enrollment.

Requirement for use of drugs that alter folate metabolism (trimethoprim/sulfamethoxazol) or reduce tubular excretion (probenecid) or known allergies to antibiotics making avoidance of trimethoprim impossible.

Current indication for methotrexate therapy.

Chronic use of oral steroid therapy or other immunosuppressive or biologic response modifiers.

NYHA Class IV congestive heart failure.

Subject is implanted with a functional and stable CRT-D or ICD system consisting of Boston Scientific MR Conditional components as specified in protocol.

Study participants must possess the β1389Arg/Arg genotype (About 50% of people with heart failure have this specific gene variant – blood test will be performed by study).

Pre-existing cardiac device that measures AF burden or agree to have a Reveal LINQ device inserted as clinically indicated to assess AF burden.

History of HFREF.

At least one symptomatic paroxysmal or persistent AF episode within 180 days.

Clinically appropriate for ECV if AF/AFL is present.

Receiving guideline indicated oral anticoagulation therapy.

NYHA Class IV symptoms.

Significant fluid overload.

More than two ECV procedures within prior 6 months.

The presence of a LVAD or a condition that is likely to require LVAD within 6 months.

History of a successful AV node ablation.

History of  AF/AFL ablation within prior 30 days

History of untreated second degree Mobitz II or third degree heart block.

History of untreated symptomatic bradycardia.

On optimal pharmacologic therapy

Existing indication for CRT device with initial implant scheduled within 1 calendar month

Ischemic or nonischemic cardiomyopathy

LVEF ≤ 35% within previous 12 calendar months

NYHA class II-IV (ambulatory)

QRS ≥ 120 ms for LBBB and ≥ 150 ms for non-LBBB patients within prior calendar year

Continuous AF > 6 calendar months

Clinical indication for single chamber pacemaker including

Life expectancy of at least one year.

Known pacemaker syndrome.

Pre-existing endocardial pacing or defibrillation leads.

Current implant of conventional or subcutaneous ICD or CRT.

Cardiovascular or peripheral vascular surgery within 30 days.

Age ≥ 65 years on date of consent.

DM treated with oral hypoglycemic agents, non-insulin injectable and/or insulin ≥ 3 months.

LVEF of 36-50% within 12 calendar months and at least 3 months after most recent MI, PCI or CABG.

Diagnosis of spontaneous AMI

Evidence of LV systolic dysfunction and/or pulmonary congestion requiring intravenous

treatment associated with the index MI event.

LVEF ≤40% after index MI presentation

At least one of the following 8 risk factors:

• Age ≥ 70 years

• eGFR <60 mL/min/1.73 m2

• Type I or II diabetes mellitus

• Documented history of prior MI

• Atrial fibrillation associated with index MI

• LVEF <30% associated with index MI

• Worst Killip class III or IV associated with index MI requiring intravenous treatment

• STEMI without reperfusion therapy within the first 24 hours after presentation

Hemodynamically stable.

≥60 years of age.

Chronic heart failure with current symptom(s) (NYHA class II-IV).

LVEF >40% by echo.

Patient with evidence of adequate functioning (e.g., intellectual, motor, visual and auditory.

Current acute decompensated HF requiring augmented therapy with diuretics,

Vasodilators and/or inotropic drugs.

Acute coronary syndrome or elective PCI within 30 days.

History of hereditary or idiopathic angioedema or angioedema related to previous ACEi or ARB therapies.

Life-threatening or uncontrolled dysrhythmia, including symptomatic or sustained ventricular tachycardia and atrial fibrillation.

Currently hospitalized for ADHF.

LVEF ≤40% within the past 6 months using Echocardiography, MUGA scan, CT scanning, MRI or ventricular angiography.

Elevated NT-proBNP ≥ 1600pg/mL OR BNP ≥400 pg/mL during current hospitalization.

Currently taking sacubitril/valsartan tablets or any use within the past 30 days.

History of hypersensitivity, contraindications, or intolerance to ACEIs, ARBs, or Sacubitril.

Known history of angioedema related to previous ACE inhibitor or ARB therapy.

Requires treatment with both ACEI and ARB.

ACS, stroke, TIA; cardiac, carotid or major CV surgery; PCI or carotid angioplasty, within 1 month.

Dyspnea due to non-cardiac, non-heart failure causes.

Intended coronary or carotid artery revascularization within the 6 months.

Implant of CRTD within 3 months or intent to implant a CRTD.

Subjects must have co-morbidities such that the surgeon and cardiologist concur that the predicted risk of operative mortality is ≥15% or a minimum STS score of 8%.

Subject has senile degenerative aortic valve stenosis with echocardiographically derived criteria:

- mean gradient >40 mmHg or

- jet velocity greater than 4.0 m/s or

- Doppler Velocity Index <0.25

- and an initial aortic valve area (AVA) of ≤ 1.0 cm2.

Subject has symptomatic aortic stenosis as demonstrated by NYHA Functional Classification of II, III, or IV.

Subject’s aortic annulus is 19-27mm diameter as measured by CT or TEE.

History of atrial fibrillation.

Taking newly-prescribed rivaroxaban for atrial fibrillation for ≤90 days or who are about to initiate therapy

Possession of a compatible smartphone with an active phone number, text and data plan.