Guideline-directed medical therapy (GDMT) with angiotensin-converting enzyme inhibitors or angiotensin receptor-neprilysin inhibitors, beta-blockers (BB), MRA and sodium-glucose cotransporter-2 inhibitors has been shown to improve survival, reduce the risk of HF hospitalizations, and reduce symptoms in patients with HF with reduced ejection fraction without LVADs.17–22 All GDMT drug classes reduce sudden cardiac death (SCD) regardless of ICD use in the absence of LVADs.23–25. This evidence concerns the gene ACE and hydrops fetalis.