For ambulatory patients with heart failure with reduced ejection fraction (HFrEF) who have not experienced a recent worsening event, cardiologists continue to face a major clinical challenge: persistent and under-recognized cardiovascular (CV) risk. Despite adherence to quadruple guideline-directed medical therapy (GDMT) and device support, these “stable,” guideline-treated patients carry residual risk for CV death. Recent evidence shows that the addition of soluble guanylate cyclase (sGC) stimulators provides significant reductions in CV death and all-cause mortality, particularly in individuals with moderately elevated NT-proBNP (≤6,000 pg/mL). However, cardiologists often underestimate risk in these ambulatory patients and may hesitate to add therapies when GDMT appears to be working well. Our experts break down a case to illustrate how and when to employ recent data regarding the use of additional sGC in appropriate patients with HFrEF.