{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:09:43Z","timestamp":1760058583090,"version":"build-2065373602"},"reference-count":25,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,4,13]],"date-time":"2025-04-13T00:00:00Z","timestamp":1744502400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Current guidelines emphasize the importance of initiating or optimizing the four pillars of heart failure with reduced ejection fraction (HFrEF) therapy\u2014beta-blockers (BB), mineralocorticoid receptor antagonists (MRA), angiotensin receptor\u2013neprilysin inhibitors (ARNI), and sodium\u2013glucose cotransporter-2 inhibitors (SGLT2i)\u2014during hospitalization for acute decompensation. This study compares clinical characteristics and outcomes in HFrEF patients hospitalized for decompensated heart failure based on whether they were newly initiated on or were already receiving at least one of these four pillars. Methods: This prospective observational study included 203 HFrEF patients hospitalized for acute decompensation. Patients were divided into two groups: Group A (n = 126), not receiving any of the four pillars prior to admission, and Group B (n = 77), receiving at least one. Clinical and biological parameters were evaluated during hospitalization, with outcomes including changes in weight, blood pressure, heart rate, renal function (serum creatinine), electrolyte levels (sodium, potassium), and 30-day mortality. Statistical analyses included the non-parametric Mann\u2013Whitney test and Chi-squared test. Results: Baseline characteristics (age, gender, LVEF, NT-proBNP) were similar between the two groups. No significant difference was observed in 30-day mortality (Group A: 7.14%, Group B: 5.55%, p = 0.74). Both groups experienced significant improvements in systolic and diastolic blood pressure and heart rate during hospitalization (p &lt; 0.05). While serum creatinine levels remained stable in both groups, creatinine dynamics (\u0394creatinine) were significantly different (p = 0.02), with Group B exhibiting a higher increase. The improvement in ejection fraction was more pronounced in Group A (p = 0.057) compared to Group B. Both groups demonstrated significant improvements in NYHA functional class (p &lt; 0.001). In Group B, the use of MRAs and SGLT2 inhibitors significantly increased during hospitalization (p = 0.01 and p &lt; 0.001, respectively). Conclusions: The initiation or optimization of the four pillars of HFrEF therapy during hospitalization for acute decompensation is feasible and well-tolerated. Early intervention leads to improvements in clinical parameters and functional status, supporting guideline recommendations for in-hospital initiation or optimization of HFrEF therapy. Special consideration should be given to renal function when optimizing therapy.<\/jats:p>","DOI":"10.3390\/jcm14082664","type":"journal-article","created":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T04:42:07Z","timestamp":1744605727000},"page":"2664","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Is It Safe to Initiate\/Optimize the Medication of HFrEF Patients During Hospitalization for Acute Decompensation?"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8267-5404","authenticated-orcid":false,"given":"Ruxandra Maria","family":"Christodorescu","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania"},{"name":"Research Center of the Institute of Cardiovascular Diseases, Gheorghe Adam St., No. 13A, 300310 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9003-456X","authenticated-orcid":false,"given":"Daniel Miron","family":"Brie","sequence":"additional","affiliation":[{"name":"Research Center of the Institute of Cardiovascular Diseases, Gheorghe Adam St., No. 13A, 300310 Timisoara, Romania"},{"name":"Cardiovascular Disease Institute Timisoara, Gheorghe Adam St., No. 13A, 300310 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alina Didu\u021ba","family":"Brie","sequence":"additional","affiliation":[{"name":"Department of Cell and Molecular Biology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Tudor Vladimirescu Street, No. 14, 300174 Timisoara, Romania"},{"name":"ANAPATMOL Research Center, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Tudor Vladimirescu Street, No. 14, 300174 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6096-9601","authenticated-orcid":false,"given":"Cristian","family":"Morno\u0219","sequence":"additional","affiliation":[{"name":"Research Center of the Institute of Cardiovascular Diseases, Gheorghe Adam St., No. 13A, 300310 Timisoara, Romania"},{"name":"Cardiovascular Disease Institute Timisoara, Gheorghe Adam St., No. 13A, 300310 Timisoara, Romania"},{"name":"Department of Cardiology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3892-0211","authenticated-orcid":false,"given":"Simona Ruxandra","family":"Dr\u0103gan","sequence":"additional","affiliation":[{"name":"Research Center of the Institute of Cardiovascular Diseases, Gheorghe Adam St., No. 13A, 300310 Timisoara, Romania"},{"name":"Cardiovascular Disease Institute Timisoara, Gheorghe Adam St., No. 13A, 300310 Timisoara, Romania"},{"name":"Department of Cardiology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Constantin Tudor","family":"Luca","sequence":"additional","affiliation":[{"name":"Research Center of the Institute of Cardiovascular Diseases, Gheorghe Adam St., No. 13A, 300310 Timisoara, Romania"},{"name":"Cardiovascular Disease Institute Timisoara, Gheorghe Adam St., No. 13A, 300310 Timisoara, Romania"},{"name":"Department of Cardiology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dan","family":"D\u0103r\u0103ban\u021biu","sequence":"additional","affiliation":[{"name":"Arad County Emergency Clinical Hospital, Andr\u00e9nyi K\u00e1roly Street, No. 2\u20134, 310037 Arad, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandru","family":"T\u00eerziu","sequence":"additional","affiliation":[{"name":"Cardiovascular Disease Institute Timisoara, Gheorghe Adam St., No. 13A, 300310 Timisoara, Romania"},{"name":"Department of Functional Sciences, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Tudor Vladimirescu Street, No. 14, 300174 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1002\/ejhf.2115","article-title":"Universal definition and classification of heart failure: A report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure","volume":"23","author":"Bozkurt","year":"2021","journal-title":"Eur. 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