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Recent studies have reported suboptimal up-titration of heart failure (HF) therapies in patients with heart failure and areduced ejection fraction (HFrEF). Here, we report on the achieved doses after nurse-led up-titration, reasons for not achieving the target dose, subsequent changes in left ventricular ejection fraction (LVEF), and mortality. From 2012 to 2018, 378 HFrEF patients with arecent ( 3months) diagnosis of HF were referred to aspecialised HF-nurse led clinic for protocolised up-titration of guideline-directed medical t