Background: : Opioid analgesics are high-alert medications known to cause adverse drug events.

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here have been numerous developments in the management of heart failure (HF) over the past several years. Terminology has evolved, with systolic dysfunction now referred to as HF with reduced ejection fraction (HFrEF) (ie, a left ventricular ejection fraction [LVEF] of ≤ 40%) (Table 1). 1,2 Medications, such as sacubitril-valsartan and sodium-glucose cotransporter-2 inhibitors (SGLT2Is), have been added to the list of agents that provide mortality and morbidity benefits in this patient population. 3 Recommended pharmacotherapy for individuals with HFrEF has subsequently expanded to include 4 types of foundational medications, also referred to as HFrEF quadruple therapy (Table 2). 3,4 Furthermore, the 2021 Canadian Cardiovascular Society (CCS) HF guidelines suggest initiating HFrEF quadruple therapy and completing titration to maximally tolerated doses within 3 to 6 months of diagnosis. 3 This may seem HF-heart failure, LVEF-left ventricular ejection fraction, NYHA-New York Heart Association. Data from Goldman et al 1 and Bozkurt et al. 2This article is eligible for Mainpro+ certified Self-Learning credits. To earn credits, go to www.cfp.ca and click on the Mainpro+ link.