We recommend an ARB be used in patients who cannot tolerate an ACEi. (Recommendation Strong, Quality High).

We recommend ARB be added to an ACEi for patients with NYHA class II to IV HF and EF ≤40 % deemed at increased risk of HF events despite optimal treatment with ACEi and beta-blocker as tolerated. (Recommendation Strong, Quality Moderate).

We recommend ARB be considered instead of an ACEi for patients with acute MI with HF or an EF <40 % who cannot tolerate an ACEi. (Recommendation Strong, Quality Moderate).

We recommend ARB be considered as adjunctive therapy to ACEi when beta-blocker is either contraindicated or not tolerated after careful attempts at initiation. (Recommendation Strong, Quality Low).

We recommend routine combination of an ACEi, ARB, and MRA not be used for patients with current or prior symptoms of HF and reduced EF. (Recommendation Strong, Quality Low).