Achieving optimal doses in treatment of heart failure with reduced ejection fraction at Gia Dinh People's Hospital

Heart failure (HF) with reduced ejection fraction (HFrEF) is a complex clinical syndrome associated with high mortality, long hospital length of stay, high readmission rates, reduced exercise tolerance, and decreased quality of life, as well as requiring significant resources to support treatment and care 1. Currently, it is reported that approximately 50% of all heart failure cases are HFrEF. However, due to recent advancements in cardiovascular diagnostic imaging, earlier, and possibly more precise, detection of HFrEF is greatly enabled. Not only does this seemingly increase the incidence rate of HfrEF in the general population, but it also gives treatment facilities an advantage in improving the prognosis and average life expectancy for these newly rising cases of HFrEF 2. According to heart failure treatment guidelines by Heart Associations around the world, an effective, interdisciplinary, and coordinated care system needs to be applied to all heart failure patients, including the reduced ejection fraction heart failure group, in order to achieve optimal guidelinesrecommended therapy, reduce mortality and readmission. In addition, each patient needs to be provided with a detailed treatment plan, which comprises treatment goals, effective management of comorbidities, follow-up time, diet, and physical activity 6. Therefore, the critical role of HF management programs in improving symptoms and quality of life in both inpatient and outpatient settings has been well recognized and paid continuous attention for the last two decades, with regular updates on team-based healthcare systems and home-based patient care 8,9,10. Recent updates in treatment guidelines have highlighted the role of the treating physician in customizing and adjusting the therapeutic drugs’ doses, to match those recommended as target or optimal, which must also be well-tolerated by the patients, with the aim of improving clinical outcomes 12. Therefore, it could be deduced that not only the sheer application of the four evidence-based foundational treatment but also dose adjustment over time of each one, should be collectively recognized as the basis of treating patients with HFrEF. The operation of a highlyspecialized unit, solely dedicated to the management of HF, known as ‘Heart Failure Unit’, has proven its effectiveness, by means of optimization of medical therapy, irrespective of baseline EF, but most notably reduced EF. Therefore, patients’ symptoms and readmission rate in facilities with “Heart Failure Unit” has witnessed a noticeable reduction. In today’s Vietnam, many tertiary medical facilities have implemented such centralized heart failure care models, and the Cardiology Department of Nhan dan Gia Dinh Hospital is definitely not an exception. The Heart Failure Unit in our department has been established and operating with a soulful dedication to providing HF patients with utmost comprehensive care and guideline-recommended therapy.