Medication Withdrawal in Stable HF With Improved LVEF

Inclusion Criteria: * Diagnosis of heart failure (HF) and use of MRAs and an ACE inhibitor/ARB/ARNI for at least 12 months * Left ventricular ejection fraction (LVEF) ≥40%, improved from a prior value ≤35%, with a sustained absolute increase \>10% * Left ventricular end-diastolic diameter within normal limits according to predefined criteria (≤59 mm for men and ≤53 mm for women) * NYHA functional class I or II * BNP levels \<100 pg/mL, or NT-proBNP levels within age-adjusted thresholds: ≥450 pg/mL for individuals \<50 years, ≥900 pg/mL for those 50-75 years, and ≥1800 pg/mL for individuals \>75 years * In cases of atrial fibrillation, NT-proBNP thresholds should be doubled * Clinical stability defined as no hospitalizations or need for increased diuretic therapy due to congestion within the previous 12 months * Optimized heart failure medications with no modifications for at least 3 months * Maximum allowed dose of furosemide of 80 mg/day * Acceptable etiologies: HF following cardiac resynchronization therapy (CRT); non-ischemic HF after myocarditis; non-ischemic HF due to tachycardiomyopathy; non-ischemic HF due to alcoholic cardiomyopathy; non-ischemic HF due to cardiotoxicity; non-ischemic HF due to peripartum cardiomyopathy; non-ischemic HF after correction or intervention for valvular disease; ischemic HF after revascularization Exclusion Criteria: * Acute coronary syndrome within the past 12 months * Arrhythmia requiring therapy within the past 12 months * Syncope or appropriate device therapy (if ICD present) within the past 12 months * Uncorrected moderate to severe valvular disease * Severe unrevascularized coronary artery disease, defined as \>50% stenosis of the left main coronary artery (LMCA) or \>70% stenosis of the left anterior descending artery (LAD), circumflex artery (LCx), or right coronary artery (RCA)