The disclosure provides methods and apparatus of particular benefit for patients suffering heart failure including cardiac dysfunction, chronic HF, and the like and all variants thereof. According to the disclosure monitoring and therapy delivery for a wide variety of acute and chronic cardiac dysfunctions are described and depicted. Various forms of paired or coupled pacing therapy delivery provided alone or in combination with neurostimulation therapy delivered by both implantable and external apparatus, including defibrillation therapy are also provided herein.