HFrEF Polypill in Sri Lanka RCT

Inclusion Criteria: 1. Adults (≥18 years old) 2. Diagnosis of heart failure with reduced ejection fraction (HFrEF) including clinical symptoms or clinical signs or natriuretic peptide elevation AND echocardiographic or other evidence of reduced left ventricular ejection fraction (EF ≤40%) 3. New York Heart Association Class II, III, or IV symptoms Exclusion Criteria: 1. Known contraindication to any of the HFrEF polypill components (e.g., advanced renal disease, bradycardia, allergy, amongst others). 2. Significant renal impairment (estimated glomerular filtration rate \<30 mL/min/1.73 m2). 3. Raised serum potassium \>5 mEq/L. 4. Symptomatic hypotension or systolic BP \<100 mmHg as per the average of last 2 of the 3 measurements at visit 1. 5. Symptomatic bradycardia or second or third-degree heart block without a pacemaker on ECG review at visit 1. 6. History of type 1 diabetes mellitus. 7. Women who are pregnant, breastfeeding or of childbearing potential and are not using and do not plan to continue using a highly acceptable form of contraception throughout the study (pharmacological or barrier methods). 8. Concomitant illness, physical impairment or mental condition which in the opinion of the study team/ primary physician could interfere with the conduct of the study including outcome assessment. 9. Participation in a concurrent interventional medical investigation or pharmacologic clinical trial. Patients in observational, natural history or epidemiological studies not involving an intervention are eligible. 10. Participant's responsible physician believes it is not appropriate for participant to participate in the study. 11. Inability or unwillingness to provide written informed consent. 12. Involvement in the planning and/or conduct of the study. 13. Unable to complete study procedures and/or plan to move out of the study site area in the next 12 months.