I have 2 macs, new one running Ventura 13.2.1, old one was on Big Sur. On the new one running Ventura, BTT keyboard triggers would stop working fairly often, like every few minutes or even more frequently, while I was working in an app. It happens at random intervals and with no apparent cause. One second the triggers work, the next second they stop working. Only the keyboard shortcuts seem to be affected, trackpad shortcuts still work, those are the only types I'm using.
I discovered that just switching to another app briefly (cmd-tab or whatever) restores the keyboard triggers.
[Edit: When the KB triggers stop working, they stop working across all apps. Just switching to another app always restores them. E.g. I was just using Chrome, then cmd-tabbed to Powerpoint, immediately hit one of my KB triggers, nothing happens. I then hit cmd-tab twice to switch back to Chrome and then back to Powerpoint, KB trigger worked. So the problem seems to be system-wide and for some reason switching window focus to another app fixes it.]
This is a company laptop, so I figured maybe it was some pesky security app that was interfering with BTT. I tried installing the priority process helper but that didn't fix it.
Today, I upgraded my other laptop to Ventura 13.2.1, and now I'm having the same problem there. I didn't make any other changes to the config on that laptop, so this seems like this may be a 13.2.1 problem.
I'll send a debug dump to your email.