Patient background: Mr. A, 58, was hospitalized for acute heart failure with reduced ejection fraction (HFrEF), showing a left ventricular ejection fraction (LVEF) of 24%. At discharge, his N-terminal pro–B-type natriuretic peptide (NT-proBNP) levels remained elevated.

Family history: His father had cardiovascular disease and died of heart failure in his 70s.

Assessment and diagnosis: Though guideline-directed medical therapy (GDMT) was initiated at discharge, target doses were rarely achieved. The early post-discharge phase is highly vulnerable and linked to increased morbidity and mortality.

Suggested treatment plan: Recognizing the risks of the post-discharge period, a six-week rapid up-titration program (RTP) was recommended. This approach aimed to optimize all four pillars of GDMT—renin-angiotensin system inhibitors (RASi), β-blockers, mineralocorticoid receptor antagonists (MRA), and sodium-glucose cotransporter 2 (SGLT2) inhibitors—in alignment with the 2023 European Society of Cardiology (ESC) heart failure guidelines.

Patient education: Mr. A was counseled on the proven benefits of comprehensive GDMT and the safety of RTP when paired with close monitoring. Emphasis was placed on adherence to therapy and regular follow-up.

Follow-up: The RTP involved six structured visits (in-hospital and remote). Clinical markers—including systolic blood pressure (SBP), heart rate (HR), renal function, potassium, and NT-proBNP—were monitored weekly. LVEF re-evaluation was scheduled 2–4 months post-RTP.

1. Why is rapid GDMT up-titration crucial immediately post-discharge for heart failure patients? Answer The early post-discharge phase is high risk. Rapid GDMT titration reduces mortality and rehospitalization by addressing this vulnerable period with evidence-based care.
2. How are safety indicators managed during RTP to ensure optimal GDMT implementation? Answer Safety parameters (eg, SBP, HR, estimated glomerular filtration rate [eGFR], potassium) are closely monitored. Most patients can achieve target GDMT doses safely with proper adjustments and follow-up.