Could heart failure patients skip some drugs after surgery? new trial investigates

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria: * Age ≥ 18 years. * Preoperative left ventricular ejection fraction (LVEF) ≤ 40% on echocardiography. * Successful surgical or procedural correction of a correctable underlying cause of heart failure: Valvular heart disease: mitral valve surgery, aortic valve surgery, transcatheter aortic valve implantation (TAVI), or tricuspid valve surgery, OR Ischemic cardiomyopathy: complete revascularization by coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). * Enrollment between 3 months before and 10 days after the corrective procedure. * Hemodynamically stable post-operative state with NYHA class I, defined at the time of randomization as: Systolic blood pressure ≥ 90 mmHg sustained for at least 6 hours; No up-titration of intravenous diuretics within the preceding 6 hours; No use of intravenous vasodilators within the preceding 6 hours; No use of intravenous inotropes within the preceding 24 hours; Heart rate 50-110 bpm and no clinical signs of volume overload. * Patients receiving ARNI or SGLT2 inhibitors prior to enrollment must complete a 1-week washout period before randomization. Provision of written informed consent. Exclusion Criteria: * Prior history of sustained ventricular tachycardia or ventricular fibrillation. * Greater-than-moderate paravalvular leak or residual mitral regurgitation after aortic or mitral valve surgery. * Incomplete revascularization in patients with coronary artery disease (residual significant disease in any major coronary territory: LAD, LCX, or RCA). * Graft occlusion documented on coronary CT angiography after CABG. Planned pregnancy during the study period. * Uncontrolled hypertension on medical therapy (systolic blood pressure \> 160 mmHg). * Estimated glomerular filtration rate (eGFR) \< 30 mL/min/1.73 m². * Inability to tolerate ARNI, defined as inability to take sacubitril/valsartan 25 mg twice daily (e.g., due to symptomatic hypotension, history of angioedema, or bilateral renal artery stenosis). * Inability to tolerate SGLT2 inhibitors (e.g., type 1 diabetes mellitus or history of recurrent diabetic ketoacidosis). * Any other condition that, in the opinion of the investigator, would interfere with study participation or follow-up.