Diuretics vs. Afterload Reduction for Treatment of HeartLogic Alerts

Inclusion Criteria:

* Boston Scientific device with HeartLogic enabled
* Lack of standard contraindications to Sacubitril/valsartan:

  * history of ACE-inhibitor induced angioedema and in those with angiotensin II receptor blocker (ARB) therapy induced angioedema.
  * hypotension, hypovolemia
  * renal artery stenosis, renal failure
  * hyperkalemia
  * hepatic disease Child-Pugh class C
  * Pregnancy/Breast-feeding
* Lack of standard contraindications to diuretic therapy
* Systolic Blood Pressure \> 105

Exclusion Criteria:

* Glomerular filtration rate \<25 mL/min who are non-responsive to diuretic therapy or are on chronic renal dialysis
* ongoing symptoms of heart failure decompensation (increased dyspnea and/or fatigue, for purposes of this study increased weight is not considered, see question 2 KCCQ).
* recent significant change in arrhythmia burden (within the past 2 weeks)
* in cardiac resynchronization therapy (CRT) patients, recent change (60 days) in effective delivery of CRT (eg. decreased biventricular paving %)
* the subject is unable to sign or refuses to sign the patient informed consent
* Symptomatic heart failure at rest or New York Heart Association Class IV at the time of enrollment
* the subject is implanted with unipolar right atrial or right ventricular leads
* subject has received or is scheduled to receive a heart transplant or ventricular assist device within the next 6 months
* subject is pregnant or planning to become pregnant during the study
* regularly scheduled IV heart failure therapy (e.g. inotropes or diuretics)