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This analysis includes HFrEF patients enrolled in the ambulatory and hospitalized cohorts with complete pharmacological data at 6-month follow-up. The objective was to describe the use of the four GDMT pillars after 6 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 3201 HFrEF patients enrolled, 142 (4.4%) had died by 6 months, and treatment data were available for 2950 patients. Mean age was 69 \u00b1 11 years (26.6% &amp;gt; 75 years), 18.0% were female. Prescription rates of GDMT were high at baseline and remained stable over 6-months, with a shift from ACE-I\/ARBs to ARNIs, and a modest increase in SGLT2i use. A significant reduction in diuretic prescription was also observed. Quadruple therapy was prescribed in 64.3% of patients at 6 months versus 63.9% at baseline\/discharge (P = NS), while quadruple therapy including ARNI went from 52.9% to 55.9%, P &amp;lt; .0001. Dose up-titration of GDMT remained suboptimal, with most agents prescribed at &amp;lt;50% of target doses. Discontinuation rates at follow-up were very low.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this large nationwide cohort, guideline-directed therapies for HFrEF were widely implemented and maintained over 6 months with excellent treatment persistence. However, dose optimization remains a key unmet need in routine clinical practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eschf\/xvag043","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T12:48:09Z","timestamp":1769690889000},"source":"Crossref","is-referenced-by-count":1,"title":["Medical treatments at 6 months in hospitalized and ambulatory HFrEF patients in the BRING-UP 3 Heart Failure study"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5827-996X","authenticated-orcid":false,"given":"Fabrizio","family":"Oliva","sequence":"first","affiliation":[{"name":"Cardiology Unit, Niguarda Hospital , Milano ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0809-1771","authenticated-orcid":false,"given":"Francesco","family":"Orso","sequence":"additional","affiliation":[{"name":"ANMCO Research Center, Heart Care Foundation , Via La Marmora 36, 50121 Firenze ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Furio","family":"Colivicchi","sequence":"additional","affiliation":[{"name":"Clinical and Rehabilitation Cardiology Unit, San Filippo Neri Hospital, ASL Roma 1 , Roma ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manlio Gianni","family":"Cipriani","sequence":"additional","affiliation":[{"name":"Clinical Cardiology and Heart Failure Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT) - 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