Objective: To observe the outcomes of the use of both Angiotensin Receptor-Neprilysin inhibitor (ARNI) and sodium-glucose cotransport 2-inhibitor (SGLT2Ii) in terms of echocardiographic parameters, clinical symptoms, cardiovascular death, and Heart failure hospitalization in patient with heart failure reduced ejection fraction (HFrEF) in the hard-to-reach rural area of Africa. Background: Angiotensin Receptor-Neprilysin inhibitor (ARNI) is preferred over angiotensin-converting enzymes inhibitor or an angiotensin II receptor blocker as foundation therapy for patients with heart failure with reduced ejection fraction to reduce the risk of cardiovascular death, Heart failure hospitalization, and Heart failure symptoms. SGLT2 inhibitor (Dapagliflozin and Empagliflozin) is among the four foundation drugs in managing HFrEF.