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The Corewell Health Heart Optimization & Evaluation (HOPE) Clinic is a multidisciplinary clinic devoted to the care of patients with advanced heart failure. The multidisciplinary team consists of Physicians, Advanced Practice Providers, RNs, Medical Assistants, Pharmacy Technician, Pharmacist, and Medical Social Workers. Additionally, HOPE offers timely referral access to a Dietician, Cardiology-Trained Psychologist and Palliative/Hospice Teams. Many advanced heart failure patients have cardiac implanted devices. HOPE promotes the use of advanced device technologies utilizing artificial intelligence to help predict when a patient may be headed toward fluid overload and decompensation. The HOPE RN Team collaborates with the Device Clinic to aid in device monitoring and management. Despite the advanced care options offered, a subset of HOPE patients will transfer to the Ventricular Assist Device (VAD)/Heart Transplant Clinic if appropriate for those services. Most of the patients will remain with the HOPE Clinic for the remainder of their life. HOPE disciplines work closely together to care for this extremely ill and vulnerable population. To optimize patient outcomes, HOPE offers an enhanced Guideline Directed Medication Titration (GDMT) Service. The GDMT Service improves heart failure outcomes by utilizing a Pharmacist and RN Team combination to rapidly titrate GDMT medications as well as to assess and monitor patients during titration.