Inclusion Criteria:  Self-identified as AA NYHA class II-IV symptoms Left ventricle EF <40% Receiving stable doses of standard therapy, including ACE inhibitors or ARBs, ARNI (within a month from discharge), combination H-ISDN, beta blockers, digoxin, spironolactone, and diuretics as tolerated. Patient must have minimum of three months follow-up  Exclusion Criteria:  Patients not meeting inclusion criteria