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We retrospectively analyzed a combined dataset from three large-scale registries of hospitalized patients with HF in Japan (NARA-HF, WET-HF, and REALITY-AHF) and patients diagnosed with HF with reduced or mildly reduced left ventricular ejection fraction (HFr\/mrEF) before admission. Patients were stratified by changes in the number of prescribed FMHF classes from admission to discharge: angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, beta-blockers, and mineralocorticoid receptor blockers. Primary endpoint was the combined endpoint of HF rehospitalization and all-cause death within 1\u00a0year of discharge. The cohort comprised 1113 patients, and 482 combined endpoints were observed. Overall, FMHF prescriptions increased in 413 (37.1%) patients (increased group), remained unchanged in 607 (54.5%) (unchanged group), and decreased in 93 (8.4%) (decreased group) at discharge compared with that during admission. In the multivariable analysis, the increased group had a significantly lower incidence of the primary endpoint than the unchanged group (hazard ratio 0.56, 95% confidence interval 0.45\u20130.60; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). 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Y.Sh. received honoraria from Otsuka, Ono, and personal fees from Nippon Shinyaku, Medtronic Japan, and Biotronik outside the submitted work. K.K. received honoraria from Daiichi-Sankyo, Ono, AstraZeneca, Otsuka, and Novartis outside the submitted work. T.O. received honoraria from Ono, Otsuka, Novartis, and AstraZeneca and research grants from Ono, Amgen, Pfizer, Alnylam, and Alexion outside the submitted work. S.K. received honoraria from Bayer and research grants from Novartis outside the submitted work. Other authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"16611"}}